Provider Demographics
NPI:1699963165
Name:CASPARIUS, KELLY HARDEE (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:HARDEE
Last Name:CASPARIUS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:BROOKE
Other - Last Name:HARDEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:5041 NEW CENTRE DR STE 112
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1624
Mailing Address - Country:US
Mailing Address - Phone:910-859-8166
Mailing Address - Fax:910-920-9878
Practice Address - Street 1:5041 NEW CENTRE DR STE 112
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1624
Practice Address - Country:US
Practice Address - Phone:910-859-8166
Practice Address - Fax:910-920-9878
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional