Individual
KYLE KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
289 INDEPENDENCE BLVD, STE 312, VIRGINIA BEACH, VA 23462-5493
(757) 385-0684
(757) 493-5456
Mailing address
289 INDEPENDENCE BLVD, STE 312, VIRGINIA BEACH, VA 23462-5493
(757) 385-0684
(757) 493-5456
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701006101
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861562472
—
VA
Enumeration date
06/25/2015
Last updated
06/25/2015
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