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General NPI Number Information
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NPI Number | 1124597711
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Entity Type | Individual
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Provider Name | KELLY ELIZABETH CONLON APC
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Gender | Female
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 965 OAKLAND RD STE 3D
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-3758
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Country | US
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Telephone | 770-495-9775
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 MANOR BRIDGE DR
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City | MILTON
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State | GA
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Zip | 30004-8822
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Country | US
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Telephone | 404-394-6698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | APC006632
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License Number State | GA
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