Individual
MRS. DIANE LYNN BRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.W., L.C.S.W.
Contact information
Practice address
14150 PARKEAST CIR, SUITE 200, CHANTILLY, VA 20151-2295
(703) 968-4036
(703) 263-1724
Mailing address
5424 BRADDOCK RIDGE DR, CENTREVILLE, VA 20120-3313
(703) 830-5378
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904001929
VA
Other
Enumeration date
08/10/2006
Last updated
07/08/2007
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