Individual
KATHY KELLOGG BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
5372 FALLOWATER LN STE C, ROANOKE, VA 24018-0950
(540) 772-1974
(540) 283-0032
Mailing address
5372 FALLOWATER LN STE C, ROANOKE, VA 24018-0950
(540) 772-1974
(540) 283-0032
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0701006731
VA
101YM0800X
Mental Health Counselor
0701006731
VA
101YP2500X
Professional Counselor
Primary
0701006731
VA
Other
Enumeration date
09/27/2016
Last updated
09/27/2016
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