Individual
DR. KIM HAVENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
10805 MAIN ST STE 500, FAIRFAX, VA 22030-4747
(703) 283-4153
Mailing address
10714 SCOTT DR, FAIRFAX, VA 22030-3023
(703) 283-4153
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810004884
VA
Other
Enumeration date
11/21/2013
Last updated
11/21/2013
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