Provider Demographics
NPI:1457726176
Name:KELLY, CAITLIN (LPC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:KELLY
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 1:6127 SYLVAN ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1033
Mailing Address - Country:US
Mailing Address - Phone:757-567-6209
Mailing Address - Fax:
Practice Address - Street 1:6127 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-1033
Practice Address - Country:US
Practice Address - Phone:757-567-6209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC102101Y00000X
VA101YM0800X
MDLC6435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor