Provider Demographics
NPI:1629340823
Name:SGROI, KELLEY (LMHC)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:SGROI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:SGROI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:185 MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28785-9696
Mailing Address - Country:US
Mailing Address - Phone:941-204-8595
Mailing Address - Fax:
Practice Address - Street 1:1777 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1078
Practice Address - Country:US
Practice Address - Phone:941-204-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20753101YM0800X
CT003449101YP2500X
CT005958124Q00000X
FLMH17027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1629340823Medicaid