Provider Demographics
NPI:1245410489
Name:MCLEOD, KELLI CHRISTINE (MA, NCC, LPC)
Entity Type:Individual
Prefix:MISS
First Name:KELLI
Middle Name:CHRISTINE
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 20387
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30325-0387
Mailing Address - Country:US
Mailing Address - Phone:770-547-1622
Mailing Address - Fax:
Practice Address - Street 1:77 COLE ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2030
Practice Address - Country:US
Practice Address - Phone:770-298-8945
Practice Address - Fax:770-919-1456
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004902101Y00000X, 101YA0400X, 101YP2500X, 251S00000X, 261QM0850X, 261QM0855X, 283Q00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No283Q00000XHospitalsPsychiatric Hospital
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility