Individual
DOMENICA KATHLEEN FAVERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 THOMSON DR, LYNCHBURG, VA 24501-1009
(434) 947-2890
Mailing address
PO BOX 11768, LYNCHBURG, VA 24506-1768
(434) 947-8290
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810003442
VA
Other
Enumeration date
03/26/2008
Last updated
03/26/2008
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