Provider Demographics
NPI:1831408129
Name:KELLEY, KATHERINE ALMA (LADC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALMA
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4517
Mailing Address - Country:US
Mailing Address - Phone:802-860-7150
Mailing Address - Fax:
Practice Address - Street 1:269 PEARL ST STE 2
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8536
Practice Address - Country:US
Practice Address - Phone:802-343-5790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000501101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)