Provider Demographics
NPI:1780697557
Name:KITCHELL, CHERIE LORA (MSW)
Entity type:Individual
Prefix:MS
First Name:CHERIE
Middle Name:LORA
Last Name:KITCHELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8413 BROOKEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1749
Mailing Address - Country:US
Mailing Address - Phone:703-851-2563
Mailing Address - Fax:
Practice Address - Street 1:9000B CROWNWOOD CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4623
Practice Address - Country:US
Practice Address - Phone:703-851-2563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040006351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491611Medicare ID - Type Unspecified