Individual
KELLY MANYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
8455 HAMPTON WAY, FAIRFAX STATION, VA 22039-2738
(703) 919-1666
Mailing address
8455 HAMPTON WAY, FAIRFAX STATION, VA 22039
(703) 919-1666
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904004334
VA
Other
Enumeration date
09/25/2013
Last updated
09/25/2013
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