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General NPI Number Information
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NPI Number | 1053045989
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Entity Type | Individual
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Provider Name | KELLEY GILBERT DAUSMAN
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Gender | Female
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 42009 VICTORY LN
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City | LEESBURG
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State | VA
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Zip | 20176-6269
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Country | US
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Telephone | 703-554-6336
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Fax |
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Provider Business Mailing Address
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Address Line | 5007 KING DAVID BLVD
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City | ANNANDALE
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State | VA
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Zip | 22003-4034
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Country | US
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Telephone | 619-876-8378
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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