Provider Demographics
NPI:1144623083
Name:SULT, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 ROSSI DR
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-8799
Mailing Address - Country:US
Mailing Address - Phone:814-244-3072
Mailing Address - Fax:
Practice Address - Street 1:7564 BROWNS MILL RD
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-9252
Practice Address - Country:US
Practice Address - Phone:717-375-1509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional