Provider Demographics
NPI:1982727327
Name:PINA, STEPHANIE MARIE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIE
Last Name:PINA
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 EXECUTIVE PARK AVENUE
Mailing Address - Street 2:#300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4647
Mailing Address - Country:US
Mailing Address - Phone:703-698-7117
Mailing Address - Fax:703-698-5729
Practice Address - Street 1:8500 EXECUTIVE PARK AVENUE
Practice Address - Street 2:#300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4647
Practice Address - Country:US
Practice Address - Phone:703-698-7117
Practice Address - Fax:703-698-5729
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-888175F00000X
VA0121000598171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath