Healthcare Provider Details

I. General information

NPI: 1245410489
Provider Name (Legal Business Name): KELLI CHRISTINE MCLEOD-ROY MA, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2784 N DECATUR RD STE 145
DECATUR GA
30033-5903
US

IV. Provider business mailing address

2784 N DECATUR RD STE 145
DECATUR GA
30033-5903
US

V. Phone/Fax

Practice location:
  • Phone: 770-298-8945
  • Fax: 855-254-4114
Mailing address:
  • Phone: 770-298-8945
  • Fax: 855-254-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLPC004902
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberLPC004902
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberLPC004902
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberLPC004902
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC004902
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC004902
License Number StateGA
# 7
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004902
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPC004902
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: