Provider Demographics
NPI:1831340918
Name:DONOVAN, KELLEY C (LCSW)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:C
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8296 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3852
Mailing Address - Country:US
Mailing Address - Phone:703-939-7724
Mailing Address - Fax:703-278-9625
Practice Address - Street 1:8296 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE C
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3852
Practice Address - Country:US
Practice Address - Phone:703-939-7724
Practice Address - Fax:703-278-9625
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040069501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical