Provider Demographics
NPI:1285863399
Name:KRISSEL, KELLY DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DIANE
Last Name:KRISSEL
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 1:2610 MARCEY RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-5232
Mailing Address - Country:US
Mailing Address - Phone:727-324-9869
Mailing Address - Fax:
Practice Address - Street 1:3033 WILSON BLVD STE 700
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3868
Practice Address - Country:US
Practice Address - Phone:727-324-9869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 89851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical