Individual
KELLY ELIZABETH ZADOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3020 JAVIER RD, FAIRFAX, VA 22031-4609
(571) 277-0217
Mailing address
1300 PELLOW CIRCLE TRL, HERNDON, VA 20170-2423
(571) 277-0217
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0710102540
VA
101YM0800X
Mental Health Counselor
Primary
0701004942
VA
Other
Enumeration date
11/27/2012
Last updated
11/27/2012
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