Healthcare Provider Details

I. General information

NPI: 1598239394
Provider Name (Legal Business Name): KELLIE WALINCHUS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 US HIGHWAY 1 STE 34
PRINCETON NJ
08540-5933
US

IV. Provider business mailing address

3495 US HIGHWAY 1 STE 34
PRINCETON NJ
08540-5933
US

V. Phone/Fax

Practice location:
  • Phone: 609-300-6502
  • Fax:
Mailing address:
  • Phone: 609-300-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00447300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00900300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: