Healthcare Provider Details

I. General information

NPI: 1346640372
Provider Name (Legal Business Name): KELLY STARNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY DAVIS

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19415 DEERFIELD AVE STE 101
LANSDOWNE VA
20176-8470
US

IV. Provider business mailing address

11835 HAZEL CIRCLE DR
BRISTOW VA
20136-2180
US

V. Phone/Fax

Practice location:
  • Phone: 703-659-1427
  • Fax:
Mailing address:
  • Phone: 703-636-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008699
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: