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General NPI Number Information
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NPI Number | 1730493438
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Entity Type | Individual
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Provider Name | CYNTHIA ANN KELLY L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 02/21/2014
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Provider Practice Location Address
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Address Line | 600 E UNAKA AVE
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City | JOHNSON CITY
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State | TN
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Zip | 37601-4035
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Country | US
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Telephone | 423-330-7943
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Fax | 877-489-8209
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Provider Business Mailing Address
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Address Line | 1535 N MAIN AVE
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City | ERWIN
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State | TN
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Zip | 37650-7995
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Country | US
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Telephone | 423-330-7943
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Fax | 877-489-8209
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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 | LSW0000005191
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License Number State | TN
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