Provider Demographics
NPI:1528391851
Name:JANE P. KALLIO, LCSW, LLC
Entity Type:Organization
Organization Name:JANE P. KALLIO, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:PHYLLIS
Authorized Official - Last Name:KALLIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-319-0128
Mailing Address - Street 1:7605 FOREST AVE STE 414
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4941
Mailing Address - Country:US
Mailing Address - Phone:804-319-0128
Mailing Address - Fax:804-592-5301
Practice Address - Street 1:7605 FOREST AVE STE 414
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4941
Practice Address - Country:US
Practice Address - Phone:804-319-0128
Practice Address - Fax:804-592-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040046671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty