Individual
CARLY IKUMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9663 MAIN ST STE D, FAIRFAX, VA 22031-3758
(703) 303-8832
Mailing address
9663 MAIN ST STE D, FAIRFAX, VA 22031-3758
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701006987
VA
Other
Enumeration date
07/19/2017
Last updated
08/18/2017
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