Provider Demographics
NPI:1689140915
Name:NELL KUSHLAK, LCSW PLLC
Entity Type:Organization
Organization Name:NELL KUSHLAK, LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUSHLAK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-242-1415
Mailing Address - Street 1:124 AMHERST ST STE 203
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4114
Mailing Address - Country:US
Mailing Address - Phone:540-242-1415
Mailing Address - Fax:540-242-1371
Practice Address - Street 1:124 AMHERST ST STE 203
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4114
Practice Address - Country:US
Practice Address - Phone:540-242-1415
Practice Address - Fax:540-242-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health