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General NPI Number Information
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NPI Number | 1508306598
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Entity Type | Individual
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Provider Name | KELLY TEJADA LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 19 E MARKET ST
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City | LEESBURG
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State | VA
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Zip | 20176-3004
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Country | US
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Telephone | 703-727-2544
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Fax |
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Provider Business Mailing Address
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Address Line | 10000 COLESVILLE RD.
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City | SILVER SPRING
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State | MD
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Zip | 20901
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Country | US
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Telephone | 240-206-1358
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 22265
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50082678
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904011780
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License Number State | VA
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