Provider Demographics
NPI:1689112997
Name:ATWOOD, KELLY (PSYD, LPC, LCP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:PSYD, LPC, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 MARTIN LUTHER KING JR WAY # 9012
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3257
Mailing Address - Country:US
Mailing Address - Phone:540-568-1735
Mailing Address - Fax:
Practice Address - Street 1:755 MARTIN LUTHER KING JR WAY # 9012
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3257
Practice Address - Country:US
Practice Address - Phone:540-568-1735
Practice Address - Fax:540-568-8866
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005578101YP2500X
VA0810005838103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional