Provider Demographics
NPI:1134564297
Name:DE CARLO, KELI DAWN (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:KELI
Middle Name:DAWN
Last Name:DE CARLO
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 LIBERTY STREET
Mailing Address - Street 2:SMITHFIELD ELEMENTARY SCHOOL
Mailing Address - City:SMITHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15478
Mailing Address - Country:US
Mailing Address - Phone:724-569-9570
Mailing Address - Fax:
Practice Address - Street 1:416 S. PITTSBURGH STREET
Practice Address - Street 2:CONNELLSVILLE COUNSELING AND PSYCHOLOGICAL SERVICES
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425
Practice Address - Country:US
Practice Address - Phone:724-626-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006874101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional