Healthcare Provider Details

I. General information

NPI: 1013793298
Provider Name (Legal Business Name): KELLEY HAMILTON FLYNN LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5408 WESTERN BLVD
RALEIGH NC
27606-1646
US

IV. Provider business mailing address

5408 WESTERN BLVD
RALEIGH NC
27606-1646
US

V. Phone/Fax

Practice location:
  • Phone: 919-909-1558
  • Fax:
Mailing address:
  • Phone: 919-909-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: