Healthcare Provider Details

I. General information

NPI: 1043339864
Provider Name (Legal Business Name): LINDA D KELLY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9228 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER VA
23061-4162
US

IV. Provider business mailing address

379 WILSON LN
WEEMS VA
22576-2202
US

V. Phone/Fax

Practice location:
  • Phone: 804-695-8120
  • Fax: 804-695-8122
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number171M00000X
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014545
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: