Healthcare Provider Details

I. General information

NPI: 1023510609
Provider Name (Legal Business Name): SUZANNE THORNTON DRAWBAUGH MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 DIANA LN
ALEXANDRIA VA
22310-3012
US

IV. Provider business mailing address

6520 DIANA LN
ALEXANDRIA VA
22310-3012
US

V. Phone/Fax

Practice location:
  • Phone: 703-317-1473
  • Fax: 703-317-3033
Mailing address:
  • Phone: 703-317-1473
  • Fax: 703-317-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0813000584
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: