Provider Demographics
NPI:1851812226
Name:KELLY, KATIE SINCLAIR (PSYD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:SINCLAIR
Last Name:KELLY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 SPRING KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3924
Mailing Address - Country:US
Mailing Address - Phone:703-307-7893
Mailing Address - Fax:
Practice Address - Street 1:1360 BEVERLY RD STE 200
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3647
Practice Address - Country:US
Practice Address - Phone:703-831-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005728103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist