Healthcare Provider Details

I. General information

NPI: 1497619316
Provider Name (Legal Business Name): KELLY NOELLE DULANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SECOND AVE STE B-300
COLLEGEVILLE PA
19426-3636
US

IV. Provider business mailing address

315 SUSQUEHANNA TRL
ALLENTOWN PA
18104-8540
US

V. Phone/Fax

Practice location:
  • Phone: 484-938-8461
  • Fax:
Mailing address:
  • Phone: 484-707-1197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: