Individual
MR. RANDY LEE SHUSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
12124 GARDEN RIDGE LN UNIT 201, FAIRFAX, VA 22030-9026
(703) 909-0820
Mailing address
12124 GARDEN RIDGE LN UNIT 201, FAIRFAX, VA 22030-9026
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
0904007117
VA
Other
Enumeration date
01/23/2013
Last updated
01/23/2013
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