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General NPI Number Information
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NPI Number | 1427440189
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Entity Type | Organization
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Legal Business Name | KMCOUNSELINGLLC
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 23 GROVES AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22305-2508
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Country | US
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Telephone | 703-887-9476
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Fax |
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Provider Business Mailing Address
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Address Line | 23 GROVES AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22305-2508
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Country | US
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Telephone | 703-887-9476
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KELLY MICHAELS MILLER
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Credential | L.C.S.W.
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Telephone | 703-887-9476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0904003516
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License Number State | VA
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