Individual
GINA PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10195 MAIN ST STE O, FAIRFAX, VA 22031-3415
(703) 332-1845
Mailing address
9068 ANDROMEDA DR, BURKE, VA 22015-3510
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904008989
VA
Other
Enumeration date
06/12/2015
Last updated
05/29/2025
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