Provider Demographics
NPI:1265000426
Name:PALMER, KELLI SPENCER (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:SPENCER
Last Name:PALMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 E CHURCH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-6208
Mailing Address - Country:US
Mailing Address - Phone:276-340-6195
Mailing Address - Fax:
Practice Address - Street 1:22 E CHURCH ST STE 310
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-6208
Practice Address - Country:US
Practice Address - Phone:276-340-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040126961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical