Individual
KELLY ANN KING LANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1503 SANTA ROSA RD RM 105, RICHMOND, VA 23229-5105
(954) 465-7494
Mailing address
3128 PARKWOOD AVE, RICHMOND, VA 23221-3537
(954) 465-7494
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904013959
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043348741
02-ORGANIZATION
VA
Enumeration date
05/18/2022
Last updated
05/18/2022
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