Provider Demographics
NPI:1528269438
Name:STEPHENSON, KELLY LUTRELL (LPC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LUTRELL
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:LUTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:8227 OLD COURTHOUSE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3815
Mailing Address - Country:US
Mailing Address - Phone:571-230-3019
Mailing Address - Fax:
Practice Address - Street 1:8227 OLD COURTHOUSE RD STE 215
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3815
Practice Address - Country:US
Practice Address - Phone:571-230-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005537101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional