Healthcare Provider Details

I. General information

NPI: 1518881747
Provider Name (Legal Business Name): KELLY MAHAN LADC, LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2969 WHITNEY AVE
HAMDEN CT
06518-2556
US

IV. Provider business mailing address

12 ELM HILL DR
WALLINGFORD CT
06492-4801
US

V. Phone/Fax

Practice location:
  • Phone: 203-909-2085
  • Fax:
Mailing address:
  • Phone: 203-909-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10044
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1681
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: