Individual
KELLY COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
1714 JARRETTSVILLE RD, JARRETTSVILLE, MD 21084-1524
(443) 695-3692
Mailing address
1405 HOWARD RD, ANNAPOLIS, MD 21403-4720
(443) 695-3692
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
15818
MD
Other
Enumeration date
10/20/2014
Last updated
10/20/2014
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