Basic Information
| Provider Information | |||||||||
| NPI: | 1588320444 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KELLEY HUNT - LCSW-LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 518 SHELTON MILL RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229037365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349962731 | ||||||||
| FaxNumber: | 4342932310 | ||||||||
| Practice Location | |||||||||
| Address1: | 509 PARK ST | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229024739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349962731 | ||||||||
| FaxNumber: | 4342932310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2021 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | HUNT | ||||||||
| AuthorizedOfficialFirstName: | KELLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4349962731 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1487085163 | 01 | TYPE 1 NPI | OTHER |