Individual
MARY JUNE C SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-3650
Mailing address
1307 VINCENT PL, MC LEAN, VA 22101-3680
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001220246
VA
163W00000X
Registered Nurse
1017196
DC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024172718
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AC002763
MD
Other
Enumeration date
06/23/2015
Last updated
08/31/2023
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