Provider Demographics
NPI:1598094898
Name:KEELY, SARAH K (LPC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:K
Last Name:KEELY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1488 AUTUMN RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1561
Mailing Address - Country:US
Mailing Address - Phone:571-269-3108
Mailing Address - Fax:
Practice Address - Street 1:491 CARLISLE DR STE B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4895
Practice Address - Country:US
Practice Address - Phone:571-269-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004688101YP2500X
MA3928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional