Provider Demographics
NPI:1699888198
Name:DEANE, KELLY LAMAR (LPC)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:LAMAR
Last Name:DEANE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 BETTERTON LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0148
Mailing Address - Country:US
Mailing Address - Phone:336-202-8173
Mailing Address - Fax:
Practice Address - Street 1:3617 BETTERTON LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0148
Practice Address - Country:US
Practice Address - Phone:336-202-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional