Healthcare Provider Details

I. General information

NPI: 1457279127
Provider Name (Legal Business Name): AVALON PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N BRADDOCK ST
WINCHESTER VA
22601-4120
US

IV. Provider business mailing address

12 N BRADDOCK ST
WINCHESTER VA
22601-4120
US

V. Phone/Fax

Practice location:
  • Phone: 540-781-1558
  • Fax:
Mailing address:
  • Phone: 540-781-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KELLY MARQUIS
Title or Position: OWNER
Credential:
Phone: 443-604-3730