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General NPI Number Information
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NPI Number | 1487148490
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Entity Type | Organization
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Legal Business Name | J L FRISTAD PLLC
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 2 CARDINAL PARK DR SE STE 104A
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City | LEESBURG
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State | VA
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Zip | 20175-4448
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Country | US
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Telephone | 703-980-9715
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Fax |
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Provider Business Mailing Address
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Address Line | 1206 MUSKET CT NE
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City | LEESBURG
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State | VA
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Zip | 20176-4805
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Country | US
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Telephone | 703-474-6202
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE OFFICER
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Name | JANICE L FRISTAD
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Credential | LCSW
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Telephone | 703-474-6202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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