Healthcare Provider Details

I. General information

NPI: 1346620440
Provider Name (Legal Business Name): KELLY LOU BROOKS CAUSEY M.S.W., L.C.S.W.-A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 N GREENSBORO ST APT 13
CARRBORO NC
27510-1364
US

IV. Provider business mailing address

4325 HALLIWELL DR
RALEIGH NC
27606-6404
US

V. Phone/Fax

Practice location:
  • Phone: 919-607-3184
  • Fax:
Mailing address:
  • Phone: 919-607-3184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP009582
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: