Organization
LIFEWORKS OUTREACH SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAUREEN VICTORIA FANNIN LCSW (CLINICAL DIRECTOR/OWNER)
(703) 580-7210
Entity
Organization
Contact information
Practice address
4300 RIDGEWOOD CENTER DR UNIT A, WOODBRIDGE, VA 22192-5307
(703) 580-7210
(703) 580-7213
Mailing address
4300 RIDGEWOOD CENTER DR UNIT A, WOODBRIDGE, VA 22192-5307
(703) 580-7210
(703) 580-7213
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1039-05-001
VA
Other
Enumeration date
11/11/2011
Last updated
11/11/2011
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