Provider Demographics
NPI:1730617762
Name:KITTEL, JONATHAN DAVID (LPC, LMFT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DAVID
Last Name:KITTEL
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 MILESTONE WAY STE D
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5091
Mailing Address - Country:US
Mailing Address - Phone:864-214-2084
Mailing Address - Fax:864-214-0229
Practice Address - Street 1:156 MILESTONE WAY STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5091
Practice Address - Country:US
Practice Address - Phone:864-214-2084
Practice Address - Fax:864-214-0229
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-03
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6535101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional