Provider Demographics
NPI:1093379117
Name:SMITH, KELCIE (MS, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:KELCIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:PA
Mailing Address - Zip Code:15419-1023
Mailing Address - Country:US
Mailing Address - Phone:610-739-3886
Mailing Address - Fax:
Practice Address - Street 1:2 EASTGATE AVE STE 102
Practice Address - Street 2:
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062-1392
Practice Address - Country:US
Practice Address - Phone:724-684-6489
Practice Address - Fax:724-684-7116
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health