Provider Demographics
NPI:1124599881
Name:GULAT, KELLY MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:GULAT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:VOIGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHP
Mailing Address - Street 1:500 OLD LYNCHBURG RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-6500
Mailing Address - Country:US
Mailing Address - Phone:434-970-1880
Mailing Address - Fax:434-970-2116
Practice Address - Street 1:800 PRESTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4420
Practice Address - Country:US
Practice Address - Phone:434-970-1880
Practice Address - Fax:434-970-1878
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007775101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional