Provider Demographics
NPI:1467086405
Name:KELLY, KATHRYN D (LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:S
Other - Last Name:DULAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:501 COLLIERS WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5003
Mailing Address - Country:US
Mailing Address - Phone:304-723-5440
Mailing Address - Fax:
Practice Address - Street 1:501 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5003
Practice Address - Country:US
Practice Address - Phone:304-723-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1373101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor