Provider Demographics
NPI:1144193087
Name:EGNACZAK, KELLI MARIE (LCMHCS, LCAS)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:MARIE
Last Name:EGNACZAK
Suffix:
Gender:F
Credentials:LCMHCS, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSYCHIATRIC SERVICES AND CONSULTATION
Mailing Address - Street 2:20 WEST COLONY PLACE #260
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705
Mailing Address - Country:US
Mailing Address - Phone:919-748-4540
Mailing Address - Fax:919-748-4564
Practice Address - Street 1:PSYCHIATRIC SERVICES AND CONSULTATION
Practice Address - Street 2:20 WEST COLONY PLACE #260
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705
Practice Address - Country:US
Practice Address - Phone:919-748-4540
Practice Address - Fax:919-748-4564
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC144101YA0400X
NC5155S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)