Provider Demographics
NPI:1184762452
Name:KINDER, KELLEY NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:NICOLE
Last Name:KINDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:NICOLE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-0426
Mailing Address - Country:US
Mailing Address - Phone:276-963-0111
Mailing Address - Fax:276-963-0005
Practice Address - Street 1:1113 CEDAR VALLEY DR
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-9190
Practice Address - Country:US
Practice Address - Phone:276-963-0111
Practice Address - Fax:276-963-0005
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008209101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional