Individual
DR. JACK KITAEFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
10560 MAIN ST, SUITE 518, FAIRFAX, VA 22030-7182
(703) 349-2999
Mailing address
9020 FORT CRAIG DR, BURKE, VA 22015-2115
(703) 501-0129
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1070
VA
Other
Enumeration date
04/11/2013
Last updated
09/29/2016
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