Provider Demographics
NPI:1558252718
Name:HETRICK, KELLY ANN (MA, COUNSELING)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:HETRICK
Suffix:
Gender:F
Credentials:MA, COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SHINEY LEAF CT
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-2559
Mailing Address - Country:US
Mailing Address - Phone:843-263-7364
Mailing Address - Fax:
Practice Address - Street 1:1555 FORDING ISLAND RD STE C1
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-1176
Practice Address - Country:US
Practice Address - Phone:843-815-6789
Practice Address - Fax:843-815-6788
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10305101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor