Healthcare Provider Details

I. General information

NPI: 1144364712
Provider Name (Legal Business Name): AMBER SMOOT KELLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 KIMEL PARK DR STE 200
WINSTON SALEM NC
27103-6185
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-7250
  • Fax:
Mailing address:
  • Phone: 336-718-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS3134
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: