Healthcare Provider Details

I. General information

NPI: 1790521615
Provider Name (Legal Business Name): PATRICIA LEE KELLY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATTI LEE KELLY

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924C DAUPHIN ISLAND PKWY # NA
MOBILE AL
36605-3004
US

IV. Provider business mailing address

1924C DAUPHIN ISLAND PKWY # NA
MOBILE AL
36605-3004
US

V. Phone/Fax

Practice location:
  • Phone: 251-476-5733
  • Fax: 251-470-7249
Mailing address:
  • Phone: 251-476-5733
  • Fax: 251-470-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4967G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: