Provider Demographics
NPI:1699306563
Name:HACKNEY, KELLY LEIGH (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LEIGH
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LEIGH
Other - Last Name:GILLIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:BIG ROCK
Mailing Address - State:VA
Mailing Address - Zip Code:24603-0283
Mailing Address - Country:US
Mailing Address - Phone:276-337-8442
Mailing Address - Fax:
Practice Address - Street 1:113 CUMBERLAND ROAD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-0810
Practice Address - Country:US
Practice Address - Phone:276-964-6702
Practice Address - Fax:276-964-0292
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional