Provider Demographics
NPI:1457171167
Name:BELLOTTI, KATLYNN (LPC-A)
Entity type:Individual
Prefix:
First Name:KATLYNN
Middle Name:
Last Name:BELLOTTI
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 STONECREST BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6633
Mailing Address - Country:US
Mailing Address - Phone:803-233-3236
Mailing Address - Fax:803-233-3236
Practice Address - Street 1:1188 STONECREST BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6633
Practice Address - Country:US
Practice Address - Phone:803-233-3236
Practice Address - Fax:803-233-3236
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCOU.10163103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling