Healthcare Provider Details

I. General information

NPI: 1952855413
Provider Name (Legal Business Name): KELLIN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 REVOLUTION MILL DR STE 34L
GREENSBORO NC
27405-5168
US

IV. Provider business mailing address

1175 REVOLUTION MILL DR STE 34L
GREENSBORO NC
27405-5168
US

V. Phone/Fax

Practice location:
  • Phone: 336-355-6206
  • Fax:
Mailing address:
  • Phone: 336-355-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3531
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLY GRAVES
Title or Position: OWNER
Credential: PHD
Phone: 336-355-6206