Healthcare Provider Details

I. General information

NPI: 1396026431
Provider Name (Legal Business Name): LISA M KELLOGG LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. LISA M DUNCAN

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 RANDOM HILLS RD STE 310
FAIRFAX VA
22030-6044
US

IV. Provider business mailing address

11350 RANDOM HILLS RD STE 310
FAIRFAX VA
22030-6044
US

V. Phone/Fax

Practice location:
  • Phone: 703-865-4900
  • Fax: 703-865-4922
Mailing address:
  • Phone: 703-865-4900
  • Fax: 703-865-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2013014601
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701010706
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP2011105
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM991
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717001833
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: