Provider Demographics
NPI:1770371569
Name:WAKEFIELD, KELLY YVETTE (MS, CSAC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:YVETTE
Last Name:WAKEFIELD
Suffix:
Gender:
Credentials:MS, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 IVYSTONE SQ APT G
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-7619
Mailing Address - Country:US
Mailing Address - Phone:213-352-7969
Mailing Address - Fax:
Practice Address - Street 1:2856 FOREHAND DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-2006
Practice Address - Country:US
Practice Address - Phone:757-861-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)