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General NPI Number Information
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NPI Number | 1871882779
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Entity Type | Individual
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Provider Name | KATE KELLEY
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Gender | Female
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/30/2018
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Provider Practice Location Address
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Address Line | 186 MAIN ST STE 2
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City | FARMINGTON
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State | ME
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Zip | 04938-1904
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Country | US
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Telephone | 207-578-2219
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Fax | 207-778-4999
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Provider Business Mailing Address
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Address Line | 150 CONGRESS ST
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City | RUMFORD
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State | ME
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Zip | 04276-2035
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAC4705
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License Number State | ME
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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 | XL3710
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License Number State | ME
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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 | CC4117
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License Number State | ME
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