Individual
DR. MICHELLE SULLIVAN-GAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
3040 WILLIAMS DR, SUITE 402, FAIRFAX, VA 22031-4618
(703) 573-3573
(703) 573-3574
Mailing address
3040 WILLIAMS DR, SUITE 402, FAIRFAX, VA 22031-4618
(703) 573-3573
(703) 573-3574
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810004489
VA
Other
Enumeration date
12/30/2011
Last updated
12/30/2011
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