Provider Demographics
NPI:1992358642
Name:WHITESELL, KELLEY LEIGH (LCSWA)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:LEIGH
Last Name:WHITESELL
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 COUNTRY CLUB RD UNIT F203
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-6289
Mailing Address - Country:US
Mailing Address - Phone:336-327-4536
Mailing Address - Fax:
Practice Address - Street 1:3710 JOHN PLATT DR STE A
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4372
Practice Address - Country:US
Practice Address - Phone:252-648-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0135481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical