MEDICARE: DONNA M KELLEY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC004484	GA

General Provider Information

NPI Number	:	1164548400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA M KELLEY LPC

Provider Business Mailing Address
First Line	:	14 CHELSEA CT
Second Line	:
City	:	AVONDALE ESTATES
State	:	GA
Zip	:	30002-1538
Country	:	US
Telephone Number	:	404-966-8054
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 CHELSEA CT
Second Line	:
City	:	AVONDALE ESTATES
State	:	GA
Zip	:	30002-1538
Country	:	US
Telephone Number	:	404-966-8054
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	02/10/2009

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