Provider Demographics
NPI:1750055612
Name:CALLAWAY, KARIS OLIVIA (LPC)
Entity Type:Individual
Prefix:
First Name:KARIS
Middle Name:OLIVIA
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2719
Mailing Address - Country:US
Mailing Address - Phone:225-371-2721
Mailing Address - Fax:
Practice Address - Street 1:316 BROOK PARK PL
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2766
Practice Address - Country:US
Practice Address - Phone:434-533-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional