Individual
MRS. KATHLEEN WAGGONER PETTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CSAC
Contact information
Practice address
19441 GOLF VISTA PLZ, SUITE 110, LANSDOWNE, VA 20176-8269
(703) 402-3080
Mailing address
2607 DEERDELL LN, RESTON, VA 20191-2114
(703) 476-5822
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/01/2010
Last updated
10/01/2010
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