Individual
SUPAVINEE PHANNGOEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2811 PENNSYLVANIA AVE SE # LL, WASHINGTON, DC 20020-3865
(202) 894-6811
Mailing address
12804 BLUHILL RD, SILVER SPRING, MD 20906-4026
(301) 267-0368
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/22/2023
Last updated
03/22/2023
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