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General NPI Number Information
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NPI Number | 1225627862
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Entity Type | Individual
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Provider Name | KELLY COLLEGE LCMHC
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Gender | Female
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Dates
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Enumeration Date | 01/17/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 6204 BATTLEFORD DR
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City | RALEIGH
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State | NC
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Zip | 27612-6604
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Country | US
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Telephone | 571-419-4451
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30881
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City | RALEIGH
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State | NC
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Zip | 27622-0881
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Country | US
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Telephone | 919-675-1395
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12688
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License Number State | NC
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