Individual
JAN R FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CSAC
Contact information
Practice address
14904 JEFFERSON DAVIS HWY STE 209, WOODBRIDGE, VA 22191-3908
(703) 595-4566
Mailing address
14904 JEFFERSON DAVIS HWY STE 209, WOODBRIDGE, VA 22191-3908
(703) 595-4566
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710000978
VA
Other
Enumeration date
09/14/2017
Last updated
09/14/2017
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