Individual
HOLLY DARA THAMMAVONGSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
46040 CENTER OAK PLZ STE 150, STERLING, VA 20166-6611
(703) 997-9494
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/20/2018
Last updated
02/20/2018
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