Provider Demographics
NPI:1730627761
Name:KNAPP, KELLI
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:KNAPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 HENDERSON DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-7420
Mailing Address - Country:US
Mailing Address - Phone:910-353-0972
Mailing Address - Fax:910-353-1439
Practice Address - Street 1:918 HENDERSON DR UNIT A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-7420
Practice Address - Country:US
Practice Address - Phone:910-353-0972
Practice Address - Fax:910-353-1439
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22589101YA0400X
101YM0800X
NC12986101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health