Provider Demographics
NPI:1336241454
Name:KAVE, VICKIE LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:LYNN
Last Name:KAVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1208 WEST BEVERLEY ST
Mailing Address - Street 2:EVERGREEN
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401
Mailing Address - Country:US
Mailing Address - Phone:540-213-1316
Mailing Address - Fax:540-213-1318
Practice Address - Street 1:1208 WEST BEVERLEY ST
Practice Address - Street 2:EVERGREEN
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401
Practice Address - Country:US
Practice Address - Phone:540-213-1316
Practice Address - Fax:540-213-1318
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040038201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8919780Medicaid