Healthcare Provider Details

I. General information

NPI: 1306775648
Provider Name (Legal Business Name): FELICIA B KALLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7008 LITTLE RIVER TPKE
ANNANDALE VA
22003-5955
US

IV. Provider business mailing address

7008 LITTLE RIVER TPKE STE G
ANNANDALE VA
22003-3234
US

V. Phone/Fax

Practice location:
  • Phone: 703-740-3700
  • Fax: 703-995-4548
Mailing address:
  • Phone: 703-704-3700
  • Fax: 703-995-4548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710103625
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: