Individual
DR. LISA M KELLOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LMFT
Contact information
Practice address
11350 RANDOM HILLS RD STE 310, FAIRFAX, VA 22030-6044
(703) 865-4900
(703) 865-4922
Mailing address
11350 RANDOM HILLS RD STE 310, FAIRFAX, VA 22030-6044
(703) 865-4900
(703) 865-4922
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0701010706
VA
101Y00000X
Counselor
P2011105
AR
101YM0800X
Mental Health Counselor
2013014601
MO
106H00000X
Marriage & Family Therapist
Primary
0717001833
VA
106H00000X
Marriage & Family Therapist
LCM991
MD
Other
Enumeration date
09/02/2011
Last updated
03/17/2026
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