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Individual

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Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
8133 LEESBURG PIKE STE 130, VIENNA, VA 22182-2706
(703) 682-0163
Mailing address
7709 MARTEL PL, SPRINGFIELD, VA 22152-1946
(703) 944-4046

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904019709
VA

Other

Enumeration date
05/30/2023
Last updated
12/29/2025
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