| Doctor Name: | MS. KELLY MARIE HASTEDT |
| NPI Number: | 1417313982 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA/ED.S, LPCA, NCC |
| License Number: | A11918 |
| Business Practice Address: | 903 Northeast Dr Suite 201 Davidson, NC - 280367416 |
| Business Phone Number: | 7048967776 |
| Business Fax Number: | |
| Mailing Address: | 8730 Pinnacle Cross Dr, Apt 8 HUNTERSVILLE |
| State: | NC |
| Postal Code: | 280784786 |
| Phone Number: | 9804068799 |
| Fax Number: | |
| NPI Enumeration Date: | 01/13/2016 |
| NPI Last Update Date: | 01/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | A11918 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |