Individual
PATRICIA ANN SUPPES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11204 WAPLES MILL RD, FAIRFAX, VA 22030-6036
(703) 218-8518
Mailing address
405 TENNESSEE AVE, ALEXANDRIA, VA 22305-1329
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0701004764
VA
Other
Enumeration date
04/12/2010
Last updated
04/12/2010
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