Individual
MS. GRACE KEIKO NOZAKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1850 CAMERON GLEN DR STE 600, RESTON, VA 20190-3343
(703) 481-4153
(703) 435-1961
Mailing address
11021 CLARA BARTON DR, FAIRFAX STATION, VA 22039-1406
(703) 593-3157
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904006574
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945107
—
VA
Enumeration date
07/26/2011
Last updated
09/04/2012
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