Healthcare Provider Details

I. General information

NPI: 1821718339
Provider Name (Legal Business Name): KELLY SNOW THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8452 RENALDS AVE
MARSHALL VA
20115-3755
US

IV. Provider business mailing address

332 W LEE HWY # 237
WARRENTON VA
20186-2428
US

V. Phone/Fax

Practice location:
  • Phone: 540-229-4920
  • Fax:
Mailing address:
  • Phone: 540-229-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KELLY SNOW-HEINZ
Title or Position: OWNER OF PLLC
Credential: LPC
Phone: 540-229-4920