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General NPI Number Information
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NPI Number | 1164857272
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Entity Type | Individual
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Provider Name | MELISSA C KEYLOR LPC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 11 HOPE ROAD SUITE 213
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City | STAFFORD
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State | VA
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Zip | 22554
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Country | US
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Telephone | 540-658-0855
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Fax | 703-368-8454
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Provider Business Mailing Address
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Address Line | 8140 ASHTON AVE 200
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City | MANASSAS
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State | VA
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Zip | 20109-5698
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Country | US
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Telephone | 703-330-9933
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Fax | 703-368-8454
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710101862
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701005458
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License Number State | VA
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