Provider Demographics
NPI:1740891100
Name:LETTIERI, KELLY WYNNE (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:WYNNE
Last Name:LETTIERI
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5401
Mailing Address - Country:US
Mailing Address - Phone:252-217-6430
Mailing Address - Fax:
Practice Address - Street 1:137 UMSTEAD HALL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-3641
Practice Address - Country:US
Practice Address - Phone:666-125-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020025038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional