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General NPI Number Information
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NPI Number | 1063101186
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Entity Type | Individual
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Provider Name | DANA AIMEE LUSK
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Gender | Female
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Dates
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Enumeration Date | 05/04/2023
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 3545 CHAIN BRIDGE RD
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City | FAIRFAX
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State | VA
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Zip | 22030-2708
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Country | US
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Telephone | 540-247-3174
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Fax |
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Provider Business Mailing Address
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Address Line | 72 COLONY AVE
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City | DALEVILLE
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State | VA
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Zip | 24083-3003
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Country | US
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Telephone | 540-247-3174
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0906013670
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License Number State | VA
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