Individual
MRS. KATHLEEN Z NUSSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12300 WASHINGTON HWY, ASHLAND, VA 23005-7646
(804) 365-4222
(804) 365-4252
Mailing address
12300 WASHINGTON HWY, ASHLAND, VA 23005-7646
(804) 365-4222
(804) 365-4252
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904001244
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
O89950
SENTARA PROVIDER NUMBER
VA
Enumeration date
10/02/2006
Last updated
07/08/2007
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