=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013474980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLEY WILLIAMS BAUGHMAN MA, LPCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2019
-----------------------------------------------------
Last Update Date | 02/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 WAKE FOREST RD STE 204
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-7451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-713-0260
-----------------------------------------------------
Fax | 919-591-0161
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2609 ALBEMARLE AVE
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27610-1833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-344-9761
-----------------------------------------------------
Fax | 919-591-0161
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | A14478
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------