Healthcare Provider Details

I. General information

NPI: 1720222359
Provider Name (Legal Business Name): KELLY WALLACE FRANZONE MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 MONTICELLO AVE.
WILLIAMSBURG VA
23188
US

IV. Provider business mailing address

P.O. BOX 6222
WILLIAMSBURG VA
23188
US

V. Phone/Fax

Practice location:
  • Phone: 757-603-4068
  • Fax: 757-877-3925
Mailing address:
  • Phone: 757-603-4068
  • Fax: 757-877-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003888
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: