Healthcare Provider Details

I. General information

NPI: 1295876332
Provider Name (Legal Business Name): KELLY S WARD PHD, LCSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MOSSY ROCK LANE
LEICESTER NC
28748
US

IV. Provider business mailing address

P.O. BOX 871
LEICESTER NC
28748
US

V. Phone/Fax

Practice location:
  • Phone: 732-328-9273
  • Fax: 732-272-0706
Mailing address:
  • Phone: 732-778-3873
  • Fax: 732-272-0706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2008R
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW44SCO4516000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC45160
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCADC37LC00085400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: