Larissa Nicole Kelly

NPI #1043857667 in Stafford, Virginia

Provider Information

NPI Number: 1043857667
Entity Type: Individual
Name: Larissa Nicole Kelly
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Dec 2, 2019
Last Updated: Dec 2, 2019

Practice Location

Address: 2761 JEFFERSON DAVIS HWY STE 107
City: Stafford
State: Virginia
ZIP Code: 22554-8330
Phone: (540) 699-3877

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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