Provider Demographics
NPI:1811168826
Name:KELLAM, KATHERINE TERESA (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:TERESA
Last Name:KELLAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13525 LELAND RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2037
Mailing Address - Country:US
Mailing Address - Phone:703-222-3558
Mailing Address - Fax:703-803-7130
Practice Address - Street 1:11835 HAZEL CIRCLE DR
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2180
Practice Address - Country:US
Practice Address - Phone:703-396-7076
Practice Address - Fax:703-361-4335
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040058061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical