Individual
KELLY LYNN COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
4103 LESTER CT, ALEXANDRIA, VA 22311-1121
(615) 335-5844
Mailing address
4103 LESTER CT, ALEXANDRIA, VA 22311-1121
(615) 335-5844
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-15-19490
—
Other
Enumeration date
07/05/2016
Last updated
07/05/2016
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