Organization
CHILD CUSTODY CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH BENNETT PHD (OWNER)
(703) 973-3863
Entity
Organization
Contact information
Practice address
6 PIDGEON HILL DR STE 190, STERLING, VA 20165-6104
(703) 973-3863
Mailing address
1901 WINTERPORT CLUSTER, RESTON, VA 20191-3623
(703) 973-3863
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
01/03/2022
Last updated
01/03/2022
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