Provider Demographics
NPI:1407697535
Name:KELLAM-KARRAS, LENA ERIKA STEPHANIE
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:ERIKA STEPHANIE
Last Name:KELLAM-KARRAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 OLDE TOWNE RD STE 10
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1986
Mailing Address - Country:US
Mailing Address - Phone:757-603-4603
Mailing Address - Fax:
Practice Address - Street 1:348 MCLAWS CIR STE 3
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6349
Practice Address - Country:US
Practice Address - Phone:757-603-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016960101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional