Provider Demographics
NPI:1255564985
Name:RODRIGUES, KELLY PRITCHETT (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:PRITCHETT
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2253
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-2253
Mailing Address - Country:US
Mailing Address - Phone:336-688-3784
Mailing Address - Fax:
Practice Address - Street 1:301 MARIAH CIR APT E18
Practice Address - Street 2:
Practice Address - City:BEECH MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28604-6830
Practice Address - Country:US
Practice Address - Phone:336-688-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7441101YM0800X, 101YP2500X
CAIMF 63488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist