Individual
JUSTIN BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 24TH ST, FORT GREGG ADAMS, VA 23801-1716
(804) 734-9000
Mailing address
228 S WASHINGTON ST STE 310, ALEXANDRIA, VA 22314-5404
(813) 731-5290
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810008092
VA
171000000X
Military Health Care Provider
0810008092
VA
Other
Enumeration date
08/06/2021
Last updated
08/16/2024
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