Kelly Elaine Vandivert, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701004449 Issued in VA

Practice address

406 Chatham SQ Park
#102
Fredericksburg, VA 22405-2585

Phone

(703) 819-7538

Fax

(540) 373-6266

NPI assigned

Nov 26, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in VA, DC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Mental Health Counselor

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

MCCD FL Psychiatry Services PAGroup PAC ID 4880064070, 751 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MCCD FL Psychiatry Services PA

  • Psychiatry Physician
  • Jacksonville, FL
  • NPI 1659003457

  DC, VA

  Medicare reassignment Care Compare group NPD
• Deer Oaks Southeast LLC

  • Clinical Psychologist
  • San Antonio, TX
  • NPI 1619112612

  VA

  Medicare reassignment NPD
• Alliance Therapy for Adults LLC

  • Clinical Social Worker
  • Fredericksburg, VA
  • NPI 1437691607
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1227657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1578718987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "186 BOULDER SPRINGS LN",
            "city": "LOUISA",
            "state": "VA",
            "postal_code": "230936229",
            "telephone_number": "540-779-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 CHATHAM SQ PARK",
            "address_2": "#102",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224052585",
            "telephone_number": "703-819-7538",
            "fax_number": "540-373-6266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDIVERT",
        "first_name": "KELLY",
        "middle_name": "ELAINE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-11-26",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701004449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004945247",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "C02810",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valley Dental Care
• Kimberley C Van Alstine, CRNA
• Kelly Renee Van Assche, A.R.N.P.
• Robyn A Van Brunt, PH.D.
• Kristen Lane Vanderwijst, DPT
• Alfreda Mayeni Vandy, RBT
• Veena N Vangani, MD
• Linda Elizabeth Vanputte, LCSW
• Vantage Professional Solutions
• Brian Stephen Vaughan, LPC

• Professional Counselor in Fredericksburg, VA
• Providers in Fredericksburg, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.