Provider Demographics
NPI:1437696689
Name:CHADWICK, KELLY MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9157 ATLEE ROAD SUITE A
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2504
Mailing Address - Country:US
Mailing Address - Phone:804-482-1403
Mailing Address - Fax:
Practice Address - Street 1:9157 ATLEE RD STE A
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2504
Practice Address - Country:US
Practice Address - Phone:804-937-5344
Practice Address - Fax:844-236-4057
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040095981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical