Provider Demographics
NPI:1427636679
Name:CHILDS, KATELYN ELIZABETH
Entity type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:CHILDS
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 1:1107 COTTONTOWN MANOR DR APT 302
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2539
Mailing Address - Country:US
Mailing Address - Phone:434-238-7709
Mailing Address - Fax:
Practice Address - Street 1:110 VISTA CENTRE DR STE 18
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2775
Practice Address - Country:US
Practice Address - Phone:434-316-6025
Practice Address - Fax:434-316-7025
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional