Provider Demographics
NPI:1982458204
Name:MACNABB, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MACNABB
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 1:10193 VALENTINO DR
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2839
Mailing Address - Country:US
Mailing Address - Phone:703-424-0626
Mailing Address - Fax:
Practice Address - Street 1:10193 VALENTINO DR
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2839
Practice Address - Country:US
Practice Address - Phone:703-424-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician