Provider Demographics
NPI:1821204959
Name:RAINNEY, KEMBERLY LILES (LPC, LSATP)
Entity Type:Individual
Prefix:DR
First Name:KEMBERLY
Middle Name:LILES
Last Name:RAINNEY
Suffix:
Gender:F
Credentials:LPC, LSATP
Other - Prefix:
Other - First Name:KEMBERLY
Other - Middle Name:ANTOINETTE
Other - Last Name:LILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LSATP
Mailing Address - Street 1:6013 MANOR HOUSE TRL
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-2248
Mailing Address - Country:US
Mailing Address - Phone:804-248-6964
Mailing Address - Fax:866-210-2370
Practice Address - Street 1:6013 MANOR HOUSE TRL
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-2248
Practice Address - Country:US
Practice Address - Phone:804-248-6964
Practice Address - Fax:866-210-2370
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002907101YP2500X
VA0718000086101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010023271Medicaid