Healthcare Provider Details

I. General information

NPI: 1528367216
Provider Name (Legal Business Name): KELLY L ANDREWS MS, LPC, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 THOROUGHGOOD RD MILITARY INTEGRATIVE THERAPIES, LLC
VIRGINIA BEACH VA
23455-4015
US

IV. Provider business mailing address

2106 THOROUGHGOOD RD MILITARY INTEGRATIVE THERAPIES, LLC
VIRGINIA BEACH VA
23455-4015
US

V. Phone/Fax

Practice location:
  • Phone: 757-995-2196
  • Fax: 757-995-2197
Mailing address:
  • Phone: 757-995-2196
  • Fax: 757-995-2197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004935
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0701004935
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: