Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 0810002112 | VA |
NPI | 1134129422 |
---|---|
Provider Name | Karen Simmons-Faber |
First Address | Virginia Beach, VA 23455-5545 |
Second Address | Virginia Beach, VA 23455-5545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0810002112 | LIC (01) | VA |
S16773 | (02) |