Provider Demographics
NPI:1164541603
Name:SANTOS, KELLIE DESIREE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:DESIREE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 CEDARCROFT DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2141
Mailing Address - Country:US
Mailing Address - Phone:931-241-1203
Mailing Address - Fax:
Practice Address - Street 1:8258 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1457
Practice Address - Country:US
Practice Address - Phone:410-263-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 0004124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE. 0004124OtherOHIO COUNSELOR, SOCIAL WORKER, AND MARRIAGE & FAMILY THERAPIST BOARD