Individual
NICOLE ALYSSA PELLICCIOTTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED, ABD
Contact information
Practice address
11642 LEEHIGH DRIVE, FAIRFAX, VA 22030-5640
(703) 819-4697
Mailing address
11642 LEEHIGH DRIVE, FAIRFAX, VA 22030-5640
(703) 819-4697
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
222Q00000X
DEVELOPMENTAL
VA
Enumeration date
05/02/2007
Last updated
07/08/2007
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