Individual
KELLY TERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
10535 CRESTWOOD DR, SUITE 201, MANASSAS, VA 20109-4416
(703) 492-2686
Mailing address
10535 CRESTWOOD DR, SUITE 201, MANASSAS, VA 20109-4416
(703) 492-2686
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904009668
VA
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
04/13/2015
Last updated
11/17/2016
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