Provider Demographics
NPI:1780406207
Name:SELLS, KAELEE RENEE
Entity type:Individual
Prefix:
First Name:KAELEE
Middle Name:RENEE
Last Name:SELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 SAVILLE GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-7032
Mailing Address - Country:US
Mailing Address - Phone:575-635-3389
Mailing Address - Fax:
Practice Address - Street 1:2909 SAVILLE GARDEN WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-7032
Practice Address - Country:US
Practice Address - Phone:575-635-3389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician