Provider Demographics
NPI:1700279635
Name:BLOCK, KELLI SUTTON (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:SUTTON
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ANN
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-1212
Mailing Address - Country:US
Mailing Address - Phone:434-806-7297
Mailing Address - Fax:
Practice Address - Street 1:420 3RD ST NE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4620
Practice Address - Country:US
Practice Address - Phone:434-806-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040087951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical