Provider Demographics
NPI:1417140245
Name:WEDELL, KELLY (EDS, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WEDELL
Suffix:
Gender:F
Credentials:EDS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 FILE ST
Mailing Address - Street 2:CLAYTON
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-3023
Mailing Address - Country:US
Mailing Address - Phone:828-545-4103
Mailing Address - Fax:
Practice Address - Street 1:31 CLAYTON ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2423
Practice Address - Country:US
Practice Address - Phone:828-545-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3897101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103683Medicaid