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MRS. SHANE SIBLEY FAGAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
919 DUKE ST, ALEXANDRIA, VA 22314-3648
(703) 864-6794
Mailing address
2316 VALLEY DR, ALEXANDRIA, VA 22302-3222
(703) 864-6794

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0904005331
VA

Other

Enumeration date
09/22/2008
Last updated
09/22/2008
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