Individual
BETHANY CORLISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
14110 ROBERT PARIS CT, CHANTILLY, VA 20151-4205
(703) 378-7998
Mailing address
13945 LEETON CIR, CHANTILLY, VA 20151-2237
(703) 887-1807
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810004470
VA
Other
Enumeration date
01/23/2015
Last updated
01/23/2015
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