Individual
TRACEY LYNETTE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3613 CHAIN BRIDGE RD STE D, FAIRFAX, VA 22030-3238
(703) 397-8163
Mailing address
3611 CHAIN BRIDGE RD STE C, FAIRFAX, VA 22030-3246
(703) 397-8163
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/06/2022
Last updated
01/06/2022
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