Healthcare Provider Details

I. General information

NPI: 1023931185
Provider Name (Legal Business Name): TRINITY RENTAS KETTLER MS, LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRINITY JADE RENTAS

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 BEDGOOD DR SW
WILSON NC
27893-8515
US

IV. Provider business mailing address

2416 BEDGOOD DR SW
WILSON NC
27893-8515
US

V. Phone/Fax

Practice location:
  • Phone: 252-265-9200
  • Fax: 252-237-8600
Mailing address:
  • Phone: 252-265-9200
  • Fax: 252-237-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23293
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: