Provider Demographics
NPI:1649503954
Name:SERGENT, KELLY MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELLE
Last Name:SERGENT
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 1:845 4TH AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1470
Mailing Address - Country:US
Mailing Address - Phone:304-523-8911
Mailing Address - Fax:304-523-8912
Practice Address - Street 1:845 4TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1470
Practice Address - Country:US
Practice Address - Phone:304-523-8911
Practice Address - Fax:304-523-8912
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WV1912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health