Individual
METKEL B RUSSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10301 DEMOCRACY LN STE 302, FAIRFAX, VA 22030-2545
(571) 223-7588
Mailing address
7115 HIGHLAND ST, SPRINGFIELD, VA 22150-3631
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/18/2025
Last updated
03/18/2025
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