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General NPI Number Information
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NPI Number | 1457450520
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Entity Type | Individual
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Provider Name | DIANNE FLINT KELLY MS
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 2759 DELK RD SE SUITE 2300
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City | MARIETTA
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State | GA
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Zip | 30067-8847
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Country | US
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Telephone | 404-822-8867
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Fax | 770-484-2749
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Provider Business Mailing Address
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Address Line | 4845 COLLINS LAKE DR
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City | MABLETON
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State | GA
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Zip | 30126-1794
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Country | US
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Telephone | 404-822-8867
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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 | MH6825
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 003356
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License Number State | GA
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