Healthcare Provider Details

I. General information

NPI: 1639783582
Provider Name (Legal Business Name): KELSEA HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 GATEHOUSE RD
FALLS CHURCH VA
22042-1203
US

IV. Provider business mailing address

8115 GATEHOUSE RD
FALLS CHURCH VA
22042-1203
US

V. Phone/Fax

Practice location:
  • Phone: 703-799-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: