Provider Demographics
NPI:1821396771
Name:REIDFORD, KELLI (LICSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:
Last Name:REIDFORD
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MONTGOMERY ST # 207
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1544
Mailing Address - Country:US
Mailing Address - Phone:571-403-2552
Mailing Address - Fax:
Practice Address - Street 1:300 MONTGOMERY ST # 207
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1544
Practice Address - Country:US
Practice Address - Phone:571-403-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500789391041C0700X
COCSW.099249221041C0700X
VA09040080971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical