Provider Demographics
NPI:1043339864
Name:KELLY, LINDA D (LPC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:KELLY
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 WILSON LN
Mailing Address - Street 2:
Mailing Address - City:WEEMS
Mailing Address - State:VA
Mailing Address - Zip Code:22576-2202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9228 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4162
Practice Address - Country:US
Practice Address - Phone:804-695-8120
Practice Address - Fax:804-695-8122
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171M00000X171M00000X
VA0701014545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator