Provider Demographics
NPI:1407222078
Name:BOYLE, KELLIE T (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:T
Last Name:BOYLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:DOENGES
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:17336 PICKWICK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6180
Mailing Address - Country:US
Mailing Address - Phone:804-207-6737
Mailing Address - Fax:
Practice Address - Street 1:17336 PICKWICK DR STE 101
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6180
Practice Address - Country:US
Practice Address - Phone:804-207-6737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006242101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health