Provider Demographics
NPI:1649956087
Name:KOROMA, IBSATU (QMHP-C)
Entity type:Individual
Prefix:
First Name:IBSATU
Middle Name:
Last Name:KOROMA
Suffix:
Gender:F
Credentials:QMHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 HARBOR CENTER DR STE 356
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2846
Mailing Address - Country:US
Mailing Address - Phone:703-831-7403
Mailing Address - Fax:703-991-6005
Practice Address - Street 1:13000 HARBOR CENTER DR STE 356
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2846
Practice Address - Country:US
Practice Address - Phone:703-831-7403
Practice Address - Fax:703-991-6005
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker