Individual
KELLY TEJADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
19 E MARKET ST, LEESBURG, VA 20176-3004
(703) 727-2544
Mailing address
10000 COLESVILLE RD., SILVER SPRING, MD 20901
(240) 206-1358
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
22265
MD
1041C0700X
Clinical Social Worker
Primary
0904011780
VA
1041C0700X
Clinical Social Worker
LC50082678
DC
Other
Enumeration date
02/24/2017
Last updated
09/06/2022
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