Healthcare Provider Details

I. General information

NPI: 1023248317
Provider Name (Legal Business Name): HILARY KELLY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CRYSTAL CT
LITTLE ROCK AR
72205-4231
US

IV. Provider business mailing address

315 CRYSTAL CT
LITTLE ROCK AR
72205-4231
US

V. Phone/Fax

Practice location:
  • Phone: 704-965-0728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4593-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: