Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 0810003939 | VA |
NPI | 1003138744 |
---|---|
Provider Name | Avy Stock |
First Address | Leesburg, VA 20176-6269 |
Second Address | Leesburg, VA 20176-6269 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2010 |
Last Update Date | 23/02/2010 |