Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | PPS-0600333 | VA |
NPI | 1023344678 |
---|---|
Provider Name | Mrs. Darlene D Roberson |
First Address | Manassas, VA 20112-8673 |
Second Address | Manassas, VA 20112-5510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2009 |
Last Update Date | 02/11/2009 |