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Organization
KEITH K. EWELL, PH.D.
Active
Organization
KEITH K. EWELL, PH.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH K. EWELL PH.D. (LICENSED CLINICAL PSYCHOLOGIST)
(703) 322-0701
Entity
Organization
Contact information
Practice address
12700 SABASTIAN DR, FAIRFAX, VA 22030-6610
(703) 322-0701
Mailing address
12700 SABASTIAN DR, FAIRFAX, VA 22030-6610
(703) 322-0701
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
0810002479
VA
Other
Enumeration date
10/06/2014
Last updated
10/06/2014
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