Individual
MRS. COLLEEN GRAYDON BASSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
815B AMBROSE LN, MANASSAS PARK, VA 20111-2706
(703) 517-3260
Mailing address
815B AMBROSE LN, MANASSAS PARK, VA 20111-2706
(703) 517-3260
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904013850
VA
Other
Enumeration date
09/06/2022
Last updated
11/18/2024
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