| Gina Park Llc | |
|
6564 Loisdale Ct Ste 600d Springfield VA 22150-1829 | |
| (703) 332-1845 | |
| Not Available |
| Full Name | Gina Park Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 6564 Loisdale Ct Ste 600d, Springfield, Virginia |
| Authorized Official Name and Position | Gina Park (OWNER) |
| Authorized Official Contact | 7033321845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gina Park Llc 9068 Andromeda Dr Burke VA 22015-3510 Ph: () - | Gina Park Llc 6564 Loisdale Ct Ste 600d Springfield VA 22150-1829 Ph: (703) 332-1845 |
| NPI Number | 1568981769 |
|---|---|
| Provider Enumeration Date | 09/19/2017 |
| Last Update Date | 11/17/2021 |
| Certification Date | 11/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568981769 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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