MEDICARE: MRS. KELLY THORNE WOODS MA, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701007632	VA

General Provider Information

NPI Number	:	1740765551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY THORNE WOODS MA, LPC, NCC

Provider Business Mailing Address
First Line	:	4542 BONNEY RD STE B
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3867
Country	:	US
Telephone Number	:	757-640-1882
Fax Number	:	757-640-0253

Provider Business Practice Location Address
First Line	:	4542 BONNEY RD STE B
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3867
Country	:	US
Telephone Number	:	757-640-1882
Fax Number	:	757-640-0253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	09/27/2018

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