Individual
MRS. HEATHER LYNNE KELLAM
Active
Individual
MRS. HEATHER LYNNE KELLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSWC
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13217
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0035
CAREFIRST BCBS-FED-PIN
MD
01
—
259147000
MAGELLAN GROUP
MD
01
—
517251
UHC MAMSI GROUP
—
01
—
522156095
AMERICAN PSYCH SYSTEM
MD
05
—
609550001
—
MD
01
—
893100-01
CAREFIRST BCBS PIN
MD
01
—
LM49EA
CAREFIRST BCBS GROUP
MD
01
—
R968
CAREFIRST FEDERAL GROUP
—
Enumeration date
11/08/2006
Last updated
12/14/2011
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