Individual
KEITH C ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
3963 FAUQUIER AVE, RICHMOND, VA 23227-4068
(804) 261-1768
Mailing address
3963 FAUQUIER AVE, RICHMOND, VA 23227-4068
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904003320
VA
Other
Enumeration date
10/27/2006
Last updated
07/08/2007
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