Individual
MIRTA LISSO CARRUTHERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6TH AND BRYANT STREETS, WASHINGTON, DC 20059-0001
(202) 806-5711
Mailing address
3603 EAST WEST HWY., CHEVY CHASE, MD 20815
(301) 986-0787
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PRC14409
DC
Other
Enumeration date
03/02/2021
Last updated
03/03/2021
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