Provider Demographics
NPI:1790392827
Name:NESBITT, KELSEY (LPC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:NESBITT
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 1:28 FARIS CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-1010
Mailing Address - Country:US
Mailing Address - Phone:864-434-1250
Mailing Address - Fax:
Practice Address - Street 1:198 ROPER MOUNTAIN ROAD EXT STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6912
Practice Address - Country:US
Practice Address - Phone:864-668-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid