Individual
MS. KELLY A BOUCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9300 DEWITT LOOP, FORT BELVOIR, VA 22060-5285
(571) 231-1356
(571) 231-6626
Mailing address
9300 DEWITT LOOP # R2.210, FORT BELVOIR, VA 22060-5285
(571) 231-1356
(571) 231-6626
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904006182
VA
Other
Enumeration date
11/23/2005
Last updated
07/07/2025
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