Provider Demographics
NPI:1205842622
Name:CONNELL, JUDITH CLEARY (LPC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:CLEARY
Last Name:CONNELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 ROTHOWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-1114
Mailing Address - Country:US
Mailing Address - Phone:434-239-0003
Mailing Address - Fax:434-239-0181
Practice Address - Street 1:18697 FOREST RD
Practice Address - Street 2:THE MADELINE CENTER
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4363
Practice Address - Country:US
Practice Address - Phone:434-239-0003
Practice Address - Fax:434-239-0181
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5414784Medicaid