Provider Demographics
NPI:1235491671
Name:HOWARD, KELLY DAVIS (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DAVIS
Last Name:HOWARD
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 1:232 LIBBY STREET
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663
Mailing Address - Country:US
Mailing Address - Phone:757-722-6864
Mailing Address - Fax:
Practice Address - Street 1:300 MEDICAL DR
Practice Address - Street 2:2ND FLR
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1765
Practice Address - Country:US
Practice Address - Phone:757-788-0092
Practice Address - Fax:757-788-0969
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional