Fountain of Life LLC
NPI #1396286019 in Falls Church, Virginia
Provider Information
- NPI Number
- 1396286019
- Entity Type
- Organization
- Organization Name
- Fountain of Life LLC
- Primary Specialty
- Psychologist - Clinical
- Enumeration Date
- Mar 14, 2017
- Last Updated
- Mar 14, 2017
Practice Location
- Address
- 450 W BROAD ST STE 211
- City
- Falls Church
- State
- Virginia
- ZIP Code
- 22046-3318
- Phone
- (571) 277-4919
Authorized Official
- Name
- DR. LISA KLEWICKI, PH.D.
- Title
- CLINICAL PSYCHOLOGIST
- Phone
- (571) 277-4919
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychologist - Clinical — Clinical |
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