Healthcare Provider Details

I. General information

NPI: 1568387116
Provider Name (Legal Business Name): AALIYAH KELLEY-GUPTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AALIYAH KELLEY-GUPTON

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11183 US 70 BUS HWY W
CLAYTON NC
27520-2364
US

IV. Provider business mailing address

1610 ARAGON DR APT 101
KNIGHTDALE NC
27545-6031
US

V. Phone/Fax

Practice location:
  • Phone: 919-243-2201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23308
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: