Provider Demographics
NPI:1689454449
Name:OTSUKA, YURINA
Entity Type:Individual
Prefix:
First Name:YURINA
Middle Name:
Last Name:OTSUKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7915 JONES BRANCH DR APT 202
Mailing Address - Street 2:
Mailing Address - City:TYSONS
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7915 JONES BRANCH DR APT 202
Practice Address - Street 2:
Practice Address - City:TYSONS
Practice Address - State:VA
Practice Address - Zip Code:22102-3230
Practice Address - Country:US
Practice Address - Phone:206-488-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC200001579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional