Provider Demographics
NPI:1356636005
Name:DIROSSI, KELLY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:DIROSSI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:VAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:650 RITCHIE HIGHWAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3935
Mailing Address - Country:US
Mailing Address - Phone:410-315-9350
Mailing Address - Fax:410-315-9353
Practice Address - Street 1:650 RITCHIE HWY
Practice Address - Street 2:SUITE 207
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3916
Practice Address - Country:US
Practice Address - Phone:410-315-9350
Practice Address - Fax:410-315-9353
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health