Individual
STEPHEN DALE FANNIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.S.
Contact information
Practice address
2801 TURNPIKE RD, PORTSMOUTH, VA 23707-4630
(757) 393-8766
Mailing address
325 COLONY RD, NEWPORT NEWS, VA 23602-6342
(757) 877-3132
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
03/08/2018
Last updated
03/08/2018
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