Individual
JACKIE L STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
410 MAPLE AVE W, SUITE 7, VIENNA, VA 22180-4224
(703) 342-4671
Mailing address
410 MAPLE AVE W, SUITE 7, VIENNA, VA 22180-4224
(703) 342-4671
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904007252
VA
Other
Enumeration date
03/04/2010
Last updated
03/04/2010
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