Individual
LISA DAVIS GORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3913 MADISON MEWS, FAIRFAX, VA 22030-2597
(703) 966-9492
Mailing address
3913 MADISON MEWS, FAIRFAX, VA 22030-2597
(703) 966-9492
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0904003629
VA
Other
Enumeration date
07/27/2022
Last updated
07/27/2022
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