Provider Demographics
NPI:1013217066
Name:GREER, KELLY (MS, LPC, CFTP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GREER
Suffix:
Gender:F
Credentials:MS, LPC, CFTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8845 SEMINOLE TRL UNIT 661
Mailing Address - Street 2:
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-3592
Mailing Address - Country:US
Mailing Address - Phone:434-337-3860
Mailing Address - Fax:434-208-3430
Practice Address - Street 1:170 S PANTOPS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8672
Practice Address - Country:US
Practice Address - Phone:434-337-3860
Practice Address - Fax:434-208-3430
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004889101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional