Provider Demographics
NPI:1679040307
Name:KELLOGG, VIRGINIA YVONNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:YVONNE
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 EASTERN AVENUE
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1677
Mailing Address - Country:US
Mailing Address - Phone:301-925-2255
Mailing Address - Fax:301-925-2020
Practice Address - Street 1:525 EASTERN AVENUE
Practice Address - Street 2:SUITE B-3
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-1677
Practice Address - Country:US
Practice Address - Phone:301-925-2255
Practice Address - Fax:301-925-2020
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03539104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical