Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 0904002357 | VA |
NPI | 1003216227 |
---|---|
Provider Name | Ms. Carol Ann Gauzens |
First Address | Mc Lean, VA 22101-0700 |
Second Address | Alexandria, VA 22308-1207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2014 |
Last Update Date | 25/08/2014 |