Provider Demographics
NPI:1508306598
Name:TEJADA, KELLY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TEJADA
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:G
Other - Last Name:CALVERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10000 COLESVILLE RD.
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901
Mailing Address - Country:US
Mailing Address - Phone:240-206-1358
Mailing Address - Fax:
Practice Address - Street 1:19 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3004
Practice Address - Country:US
Practice Address - Phone:703-727-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22265104100000X
DCLC500826781041C0700X
VA09040117801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker