Individual
KELLY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
42009 VICTORY LN, LEESBURG, VA 20176-6269
(703) 777-0800
Mailing address
11835 HAZEL CIRCLE DR, BRISTOW, VA 20136-2180
(703) 636-5100
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904008699
VA
Other
Enumeration date
08/27/2014
Last updated
02/12/2019
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