Organization
DEPARTMENT OF DEFENSE
Active
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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