Individual
KELLY BROADWATER PICKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPA, LPC, CEDS
Contact information
Practice address
3240 BURNT MILL DR, SUITE 1, WILMINGTON, NC 28403-2576
(910) 790-9500
(910) 796-8111
Mailing address
3240 BURNT MILL DR, SUITE 1, WILMINGTON, NC 28403-2576
(910) 790-9500
(910) 796-8111
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2481
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046XA
BCBS
NC
Enumeration date
09/28/2006
Last updated
07/28/2015
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