Provider Demographics
NPI:1417720863
Name:CAMP, KELLY LOUISE (LMFT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LOUISE
Last Name:CAMP
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 S. CAMERON STREET
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-1803
Mailing Address - Country:US
Mailing Address - Phone:540-223-2278
Mailing Address - Fax:
Practice Address - Street 1:132 S CAMERON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4733
Practice Address - Country:US
Practice Address - Phone:540-223-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001792106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist