Healthcare Provider Details

I. General information

NPI: 1366462145
Provider Name (Legal Business Name): KELLY MARIE LEHMAN LPC, M.ED, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date: 01/30/2022
Reactivation Date: 05/11/2023

III. Provider practice location address

11576 GALLATIN TRL
PARRISH FL
34219-2392
US

IV. Provider business mailing address

1703 COUNTRY CLUB RD SUITE 204
JACKSONVILLE NC
28546-6008
US

V. Phone/Fax

Practice location:
  • Phone: 813-563-5299
  • Fax:
Mailing address:
  • Phone: 910-347-3010
  • Fax: 910-347-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5131
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: