Individual
CARLISSA AVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7516 BROOKSHIRE DR, PRINCE GEORGE, VA 23875-3145
(313) 828-2399
Mailing address
722 C ST, PETERSBURG, VA 23803-5206
(313) 828-2399
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
VA
Other
Enumeration date
01/30/2024
Last updated
01/30/2024
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