Individual
GAYLE P NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1850 CAMERON GLEN DR, RESTON, VA 20190-3363
(703) 481-4011
(703) 481-1420
Mailing address
1850 CAMERON GLEN DR, RESTON, VA 20190-3363
(703) 481-4011
(703) 481-1420
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0904005220
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99999
—
VA
Enumeration date
12/08/2008
Last updated
03/29/2021
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