Provider Demographics
NPI:1760031108
Name:DENNISON, KALLY (LPCMH)
Entity Type:Individual
Prefix:MRS
First Name:KALLY
Middle Name:
Last Name:DENNISON
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:MS
Other - First Name:KALLY
Other - Middle Name:
Other - Last Name:REICHHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:908 SE FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1556
Mailing Address - Country:US
Mailing Address - Phone:302-236-0077
Mailing Address - Fax:
Practice Address - Street 1:103 MONT BLANC BLVD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7615
Practice Address - Country:US
Practice Address - Phone:302-678-3020
Practice Address - Fax:302-678-2458
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-000958101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional