Provider Demographics
NPI:1497869598
Name:KELL, JENNIFER ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:KELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4504
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-0010
Mailing Address - Country:US
Mailing Address - Phone:804-317-5710
Mailing Address - Fax:804-763-3453
Practice Address - Street 1:9513 HULL STREET RD STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-1495
Practice Address - Country:US
Practice Address - Phone:804-608-9389
Practice Address - Fax:804-763-3453
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040044891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010210607Medicaid
VA010210607Medicaid