Provider Demographics
NPI:1730236415
Name:SAVAGE, KELLYANNE (LCSW)
Entity type:Individual
Prefix:
First Name:KELLYANNE
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1522
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555-1522
Mailing Address - Country:US
Mailing Address - Phone:540-226-0787
Mailing Address - Fax:888-587-3511
Practice Address - Street 1:1300 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7232
Practice Address - Country:US
Practice Address - Phone:540-226-0787
Practice Address - Fax:888-587-3511
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040064861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical