Individual
MS. KELLI M CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ICSW
Contact information
Practice address
113 QUAIL RIDGE LN, RIDGELEY, WV 26753-5200
(301) 268-1699
Mailing address
113 QUAIL RIDGE LN, RIDGELEY, WV 26753-5200
(301) 268-1699
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
12834
MD
1041C0700X
Clinical Social Worker
Primary
DP00943767
WV
Other
Enumeration date
04/29/2011
Last updated
04/29/2011
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