Individual
MRS. KELLY ODEA LANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
922 9 AND A HALF ST, CHARLOTTESVILLE, VA 22903
(434) 981-4686
(434) 977-6323
Mailing address
304 ELLINGTON BEND, CHARLOTTESVILLE, VA 22903
(434) 981-4686
(434) 977-6323
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904005663
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11526617
CAQH
—
Enumeration date
01/03/2007
Last updated
07/08/2007
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