Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 0701007913 | VA |
N | 101YP1600X | Pastoral Counselor |
NPI | 1093177644 |
---|---|
Provider Name | Mrs. Audra Irene Mrini |
First Address | Fairfax, VA 22030 |
Second Address | Fairfax, VA 22030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 10/02/2022 |