Individual
ELAINE VICCORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
10195 MAIN ST, SUITE N, FAIRFAX, VA 22031-3415
(703) 250-6785
Mailing address
7103 WOODGLEN CT, FAIRFAX STATION, VA 22039-1707
(703) 250-5012
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904004318
VA
Other
Enumeration date
05/26/2010
Last updated
05/26/2010
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