Provider Demographics
NPI:1033251996
Name:KELLY, VIRGINIA (LPC, PHD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:PROCTORSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05153-0093
Mailing Address - Country:US
Mailing Address - Phone:802-558-9498
Mailing Address - Fax:203-254-4047
Practice Address - Street 1:56 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2963
Practice Address - Country:US
Practice Address - Phone:802-558-9498
Practice Address - Fax:203-254-4047
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CT001449101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6706237Medicaid