Organization
KEITH K. EWELL, PH.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH K. EWELL PH.D. (LICENSED CLINICAL PSYCHOLOGIST)
(703) 322-0701
Entity
Organization
Contact information
Practice address
12700 SABASTIAN DR, FAIRFAX, VA 22030-6610
(703) 322-0701
Mailing address
12700 SABASTIAN DR, FAIRFAX, VA 22030-6610
(703) 322-0701
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
0810002479
VA
Other
Enumeration date
10/06/2014
Last updated
10/06/2014
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