Individual
KELLY FACCIOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12866 HARBOR DR, WOODBRIDGE, VA 22192-2921
(703) 494-4164
(703) 563-9304
Mailing address
12866 HARBOR DR, WOODBRIDGE, VA 22192-2921
(703) 203-7535
(703) 563-9304
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904005064
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010023700
—
VA
Enumeration date
08/25/2006
Last updated
08/07/2019
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