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General NPI Number Information
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NPI Number | 1366815755
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Entity Type | Individual
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Provider Name | RUTH KELLAM KERLEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 05/15/2019
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Provider Practice Location Address
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Address Line | 3625 N ELM ST STE 110A
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City | GREENSBORO
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State | NC
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Zip | 27455-2697
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Country | US
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Telephone | 703-888-7728
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Fax |
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Provider Business Mailing Address
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Address Line | 7024 CARRIAGE COVE DR
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City | OAK RIDGE
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State | NC
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Zip | 27310-8001
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Country | US
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Telephone | 703-888-7728
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C011719
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License Number State | NC
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