Provider Demographics
NPI:1285342956
Name:WRIGHT, KELLI RANDALL
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:RANDALL
Last Name:WRIGHT
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 1:416 E CALHOUN ST STE B
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5852
Mailing Address - Country:US
Mailing Address - Phone:864-642-1171
Mailing Address - Fax:864-642-0945
Practice Address - Street 1:416 E CALHOUN ST STE B
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5852
Practice Address - Country:US
Practice Address - Phone:864-642-1171
Practice Address - Fax:864-642-0945
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health