Provider Demographics
NPI:1013420256
Name:HOPKINS, KELLIE A (LISW, LICDC)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:A
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9417
Mailing Address - Country:US
Mailing Address - Phone:419-405-3899
Mailing Address - Fax:419-405-3899
Practice Address - Street 1:5151 MONROE ST STE 200
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3466
Practice Address - Country:US
Practice Address - Phone:419-405-3899
Practice Address - Fax:419-405-3899
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC161960101YA0400X
OHI.22037501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)