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General NPI Number Information
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NPI Number | 1366420192
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Entity Type | Individual
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Provider Name | SUZANNE AUTREY KELLY LPC,LCAS,CEAP
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Gender | Female
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 110 W ELM ST
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City | YADKINVILLE
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State | NC
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Zip | 27055-1758
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Country | US
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Telephone | 336-677-3991
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Fax | 336-677-1359
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Provider Business Mailing Address
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Address Line | 110 W ELM ST # 1758
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City | YADKINVILLE
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State | NC
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Zip | 27055-8203
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Country | US
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Telephone | 336-466-1053
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Fax | 336-677-1359
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 60
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1223
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1070
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License Number State | NC
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