Provider Demographics
NPI:1497085385
Name:LITTLEFIELD, KELLI SUZANNE (EDS, LPC, CRC, NCC)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:SUZANNE
Last Name:LITTLEFIELD
Suffix:
Gender:F
Credentials:EDS, LPC, CRC, NCC
Other - Prefix:MISS
Other - First Name:KELLI
Other - Middle Name:LITTLEFIELD
Other - Last Name:MISCHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, CRC
Mailing Address - Street 1:100 BLUE FIN CIR STE 4
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2463
Mailing Address - Country:US
Mailing Address - Phone:912-373-6789
Mailing Address - Fax:912-257-4413
Practice Address - Street 1:100 BLUE FIN CIR STE 4
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410
Practice Address - Country:US
Practice Address - Phone:912-373-6789
Practice Address - Fax:912-257-4413
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 007122101YA0400X, 101YM0800X
GALPC007122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003147350AMedicaid