Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 0701004421 | VA |
NPI | 1003169681 |
---|---|
Provider Name | Jessica Macnair |
First Address | Falls Church, VA 22042-2003 |
Second Address | Falls Church, VA 22042-2003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2012 |
Last Update Date | 19/10/2012 |