Healthcare Provider Details

I. General information

NPI: 1235804386
Provider Name (Legal Business Name): KIRSTEN SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S KING ST
LEESBURG VA
20175-2905
US

IV. Provider business mailing address

832 HAWKS RUN CT SE
LEESBURG VA
20175-5639
US

V. Phone/Fax

Practice location:
  • Phone: 703-297-4368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: