Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 0701008678 | VA |
N | 101YP1600X | Pastoral Counselor |
NPI | 1093357881 |
---|---|
Provider Name | James Joseph Rubin |
First Address | Manassas, VA 20110-4766 |
Second Address | Manassas, VA 20110-4766 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2019 |
Last Update Date | 13/10/2019 |