Provider Demographics
NPI:1740765551
Name:WOODS, KELLY THORNE (MA, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:THORNE
Last Name:WOODS
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4542 BONNEY RD STE B
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3867
Mailing Address - Country:US
Mailing Address - Phone:757-640-1882
Mailing Address - Fax:757-640-0253
Practice Address - Street 1:4542 BONNEY RD STE B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3867
Practice Address - Country:US
Practice Address - Phone:757-640-1882
Practice Address - Fax:757-640-0253
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional