Provider Demographics
NPI:1639323108
Name:WARD, VALERIE KELLAM (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:KELLAM
Last Name:WARD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14433 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:MD
Mailing Address - Zip Code:21822-2339
Mailing Address - Country:US
Mailing Address - Phone:443-944-0794
Mailing Address - Fax:
Practice Address - Street 1:111 W MAIN ST UNIT E
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4973
Practice Address - Country:US
Practice Address - Phone:443-944-0794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD774800100Medicaid