Individual
SHANNON M WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MM, MS
Contact information
Practice address
3925 BLENHEIM BLVD STE 52B, FAIRFAX, VA 22030-2426
(571) 418-1714
Mailing address
1295 MASON MILL CT, HERNDON, VA 20170-5740
(703) 577-3005
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0704016928
VA
Other
Enumeration date
05/30/2024
Last updated
05/30/2024
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