Healthcare Provider Details

I. General information

NPI: 1477021186
Provider Name (Legal Business Name): JILLIAN KELLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 E CHESTNUT ST
ASHEVILLE NC
28801-2330
US

IV. Provider business mailing address

191 E CHESTNUT ST
ASHEVILLE NC
28801-2330
US

V. Phone/Fax

Practice location:
  • Phone: 399-870-3363
  • Fax:
Mailing address:
  • Phone: 339-987-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JILLIAN E KELLY
Title or Position: AUTHORIZED OFFICIAL
Credential: LCSW
Phone: 339-987-0336