Healthcare Provider Details

I. General information

NPI: 1073983672
Provider Name (Legal Business Name): DIONNE DETOUCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2838 BEECHTREE LN
WOODBRIDGE VA
22191-4640
US

IV. Provider business mailing address

2838 BEECHTREE LN
WOODBRIDGE VA
22191-4640
US

V. Phone/Fax

Practice location:
  • Phone: 540-369-6788
  • Fax: 540-369-6091
Mailing address:
  • Phone: 540-369-6788
  • Fax: 540-369-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number251B00000X
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: