James Joseph Kelly IV

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701011158 Issued in VA

Practice address

11835 Hazel Circle Dr
Bristow, VA 20136-1223

Phone

(703) 636-5104

NPI assigned

Feb 3, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1643846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1740934207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12463 HADRIANS CT",
            "city": "BRISTOW",
            "state": "VA",
            "postal_code": "201363074",
            "telephone_number": "267-825-3645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11835 HAZEL CIRCLE DR",
            "city": "BRISTOW",
            "state": "VA",
            "postal_code": "201361223",
            "telephone_number": "703-636-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JAMES",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-03",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701011158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Jkelly@yftva.com",
            "affiliation": "Y",
            "endpointDescription": "Practice email",
            "affiliationName": "Youth For Tomorrow New Life Center, Inc.",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11835 Hazel Circle Dr",
            "city": "Bristow",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201361223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hye Jung Kang, PHARMACIST
• Jina Kang, BCBA, MED, LBA
• Kamalpreet Kaur, RPH
• Kayjoy Healthcare Services
• Katherine Teresa Kellam, LCSW
• Parveen Kelly, CPM, LM
• Brenda Lee Knighton, IBCLC
• Kathryn Leah Knodt, PTA
• Kristen Patricia Kolumbic, LCSW
• Andrea Cline Lafferty

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.