Provider Demographics
NPI:1790525392
Name:WHITE, KELLY SPAHR (MED, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SPAHR
Last Name:WHITE
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRACEY
Mailing Address - State:VA
Mailing Address - Zip Code:23919-1630
Mailing Address - Country:US
Mailing Address - Phone:540-312-8814
Mailing Address - Fax:
Practice Address - Street 1:219 E ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2003
Practice Address - Country:US
Practice Address - Phone:540-312-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133003639103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst