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General NPI Number Information
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NPI Number | 1770371569
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Entity Type | Individual
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Provider Name | KELLY YVETTE WAKEFIELD MS, CSAC
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Gender | Female
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 2856 FOREHAND DR
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City | CHESAPEAKE
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State | VA
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Zip | 23323-2006
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Country | US
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Telephone | 757-861-9020
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Fax |
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Provider Business Mailing Address
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Address Line | 1142 IVYSTONE SQ APT G
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City | CHESAPEAKE
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State | VA
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Zip | 23320-7619
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Country | US
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Telephone | 213-352-7969
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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