Kelly Leigh Hackney, LPC
Individual provider Active NPI Professional Counselor · Cedar Bluff, VA
NPI 1699306563 · NPPES record last updated Feb 12, 2025
Key facts
- NPI
- 1699306563
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 0701008891 (VA)
- Practice address
- 113 Cumberland Road
Cedar Bluff, VA 24609-0810 - Phone
- (276) 964-6702
- Fax
- (276) 964-0292
- NPI assigned
- Jan 30, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA, DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240424000575 | VA | Practitioner - Mental Health Counselor | 6103265186 | Reassigns benefits to 1 organization |
| I20250225002869 | DC | Practitioner - Mental Health Counselor | 6103265186 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Professional | Current |
Accepting new patients |
| Cumberland Mountain Community Services | Current |
Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
196 Cumberland Rd
Cedar Bluff, VA 24609
526 Main St
Tazewell, VA 24651
Phone (276) 988-7961
578 Main St
Tazewell, VA 24651
Phone (276) 988-0081
8300 Boone Blvd
Ste 500
Vienna, VA 22182
Phone (703) 884-2598
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701008891 | VA | Yes |
Addresses
Primary practice location
113 Cumberland Road
Cedar Bluff, VA 24609-0810
Mailing address
PO Box 283
Big Rock, VA 24603-0283
Phone (276) 337-8442
Other practice location 1
216 Gilmer Street
Lebanon, VA 24266
Phone (276) 889-3063
Other practice location 2
196 Cumberland Rd
Cedar Bluff, VA 24609-1137
Phone (276) 964-6702
Other practice location 3
78 Rogers Street
Lebanon, VA 24266
Phone (276) 935-7154
Other practice location 4
526 West Main Street
Tazewell, VA 24651
Phone (276) 988-7961
Other practice location 5
1014 Stillhouse Hollow Road
Grundy, VA 24614
Phone (276) 935-7154
Other names
- Kelly Leigh Gilliam
Other providers in Cedar Bluff, VA
- Amber Goodman
- Brittany N Goss
- Susan Gail Green
- Jordan Dean Griffith
- Juanita Marie Gross
- Cynthia H Hale
- Karen Lynn Harrison
- Sandy Jo Hess
- Jeani Renee Hodges
- Sandra Kay Horne
All providers in Cedar Bluff, VA · Professional Counselor in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.