Provider Demographics
NPI:1396026431
Name:KELLOGG, LISA M (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10560 ARROWHEAD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7322
Mailing Address - Country:US
Mailing Address - Phone:703-865-4900
Mailing Address - Fax:703-865-4922
Practice Address - Street 1:10560 ARROWHEAD DR STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7322
Practice Address - Country:US
Practice Address - Phone:703-865-4900
Practice Address - Fax:703-865-4922
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010706101Y00000X
ARP2011105101Y00000X
MO2013014601101YM0800X
MDLCM991106H00000X
VA0717001833106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health