Organization
DEPARTMENT OF DEFENSE
Active
Other names
United States Army
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHELIA REDMOND MSW (PROGRAM DIRECTOR)
(703) 576-1403
Entity
Organization
Contact information
Practice address
14450 SMOKETOWN RD, WOODBRIDGE, VA 22192-4712
(703) 576-1397
Mailing address
1949 POHICK CREEK CT, WOODBRIDGE, VA 22192-2428
(703) 492-9112
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0904004811
VA
Other
Enumeration date
10/26/2005
Last updated
08/22/2020
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