Provider Demographics
NPI:1225396104
Name:ZERFOSS, KELLY BITTNER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:BITTNER
Last Name:ZERFOSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 OPITZ BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-6822
Mailing Address - Country:US
Mailing Address - Phone:703-357-9664
Mailing Address - Fax:
Practice Address - Street 1:2680 OPITZ BLVD STE 220
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6822
Practice Address - Country:US
Practice Address - Phone:703-357-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040078961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical