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General NPI Number Information
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NPI Number | 1629340823
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Entity Type | Individual
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Provider Name | KELLEY SGROI LMHC
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Gender | Female
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1777 TAMIAMI TRL
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1078
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Country | US
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Telephone | 941-204-8595
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Fax |
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Provider Business Mailing Address
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Address Line | 185 MIDLAND DR
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City | WAYNESVILLE
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State | NC
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Zip | 28785-9696
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Country | US
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Telephone | 941-204-8595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 20753
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 003449
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 005958
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH17027
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License Number State | FL
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