Provider Demographics
NPI:1285922211
Name:WESTBERRY, KELLIE MELISSA (LCS5298, CCS7163)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:MELISSA
Last Name:WESTBERRY
Suffix:
Gender:F
Credentials:LCS5298, CCS7163
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 COMMONS AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5836
Mailing Address - Country:US
Mailing Address - Phone:207-550-7439
Mailing Address - Fax:207-893-8611
Practice Address - Street 1:19 COMMONS AVE STE 7
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5836
Practice Address - Country:US
Practice Address - Phone:207-550-7439
Practice Address - Fax:207-893-8611
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC5298101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)