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General NPI Number Information
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NPI Number | 1720626468
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Entity Type | Individual
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Provider Name | WAYNE XAVIER SASSO
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Gender | Male
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 118 LONG POND RD STE 105
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City | PLYMOUTH
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State | MA
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Zip | 02360-2662
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Country | US
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Telephone | 703-992-5806
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Fax |
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Provider Business Mailing Address
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Address Line | 21412 GLEBE VIEW DR
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City | BROADLANDS
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State | VA
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Zip | 20148-3601
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Country | US
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Telephone | 703-992-5806
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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 |
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License Number State |
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