Individual
MR. CONSTANTINE THEODORE CHELPON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5610 SANDY LEWIS DR STE A, FAIRFAX, VA 22032-4045
(703) 425-8269
Mailing address
5610 SANDY LEWIS DR STE A, FAIRFAX, VA 22032-4045
(703) 425-8269
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904004772
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1775906
—
VA
01
—
630209
ANTHEM
VA
01
—
C741
CARE FIRST
VA
Enumeration date
10/19/2006
Last updated
07/08/2007
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