Provider Demographics
NPI:1417683764
Name:KEY, VINCENT DURRELL (LCSW)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:DURRELL
Last Name:KEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 WITTYS WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2251
Mailing Address - Country:US
Mailing Address - Phone:205-907-4507
Mailing Address - Fax:
Practice Address - Street 1:5913 CHALKELY RD
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-8037
Practice Address - Country:US
Practice Address - Phone:205-907-4507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040141811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty