Individual
DIANE PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LMFT
Contact information
Practice address
9675-A MAIN STREET, FAIRFAX, VA 22031
(703) 405-2582
Mailing address
9618 DUBLIN DRIVE, MANASSAS, VA 20109-3356
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701002623
VA
Other
Enumeration date
09/25/2006
Last updated
07/08/2007
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