Provider Demographics
NPI:1023635612
Name:CARNEY, KAITLYN ALISE (LPC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ALISE
Last Name:CARNEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 PRIMROSE LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-3012
Mailing Address - Country:US
Mailing Address - Phone:910-309-8030
Mailing Address - Fax:
Practice Address - Street 1:1610 GRAVES MILL RD UNIT A
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4329
Practice Address - Country:US
Practice Address - Phone:434-258-0591
Practice Address - Fax:434-608-0505
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional