Individual
KELLY HEIGES THEIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
8381 OLD COURTHOUSE ROAD, SUITE 330, VIENNA, VA 22182-1670
(703) 938-9090
(703) 938-9091
Mailing address
1428 ALDENHAM LN, RESTON, VA 20190-3901
(703) 864-5416
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
081003318
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010099072
—
VA
01
—
139309
ANTHEM HK
VA
01
—
293937
AMERIGROUP
VA
01
—
541598045
NCPPO
VA
01
—
715692000
MAGELLAN
VA
01
—
7751599
AETNA
VA
01
—
89130026
CAREFIRST BCBS
VA
Enumeration date
09/15/2006
Last updated
09/01/2015
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