Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 0718000189 | VA |
NPI | 1427231513 |
---|---|
Provider Name | Dr. Stella Brizuela-Moreno |
First Address | Annandale, VA 22003-1202 |
Second Address | Annandale, VA 22003-1202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2007 |
Last Update Date | 11/12/2007 |