=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750174181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KELLIE HOPKINS, LICDC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2025
-----------------------------------------------------
Last Update Date | 05/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5151 MONROE ST STE 200
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43623-3466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-405-3899
-----------------------------------------------------
Fax | 419-405-3899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3144 WHITE ST
-----------------------------------------------------
City | LAMBERTVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48144-9417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-405-3899
-----------------------------------------------------
Fax | 419-405-3899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | KELLIE ANN HOPKINS
-----------------------------------------------------
Credential | LISW, LICDC
-----------------------------------------------------
Telephone | 419-405-3899
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------