Individual
SHANNON MARIE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, BCBA
Contact information
Practice address
10530 WARWICK AVE, SUITE C5, FAIRFAX, VA 22030-3132
(703) 216-9230
(571) 384-5815
Mailing address
10530 WARWICK AVE, SUITE C5, FAIRFAX, VA 22030-3132
(703) 216-9230
(571) 384-5815
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-11-9387
VA
Other
Enumeration date
11/28/2011
Last updated
09/12/2012
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