Individual
TAE JU OH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10560 MAIN ST STE 508, FAIRFAX, VA 22030-7173
(703) 277-9515
Mailing address
4385 PATRIOT PARK CT, FAIRFAX, VA 22030-4333
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LGP11527
MD
101YM0800X
Mental Health Counselor
Primary
0732001946
VA
101YM0800X
Mental Health Counselor
0733001708
VA
Other
Enumeration date
08/03/2021
Last updated
08/03/2021
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