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21228 Hedgerow Ter. Ashburn VA 20147 | |
| (703) 539-9242 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 21228 Hedgerow Ter., Ashburn, Virginia |
| Authorized Official Name and Position | Irene Teresa Paz Pruitt (OWNER) |
| Authorized Official Contact | 5712661808 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
21228 Hedgerow Ter. Ashburn VA 20147 Ph: (703) 539-9242 | 21228 Hedgerow Ter. Ashburn VA 20147 Ph: (703) 539-9242 |
| NPI Number | 1992529416 |
|---|---|
| Provider Enumeration Date | 11/12/2024 |
| Last Update Date | 11/18/2024 |
| Certification Date | 11/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992529416 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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