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NPI Code Detail

MEDICARE: KELLY DRISCOLL LPCA, NCC

MEDICARE: KELLY DRISCOLL LPCA, NCC
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
1101YM0800XMental Health CounselorA10264NC

General Provider Information

NPI Number : 1841625340
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY DRISCOLL LPCA, NCC
Provider Business Mailing Address
First Line : PO BOX 1738
Second Line :
City : LUMBERTON
State : NC
Zip : 28359-1738
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7489 ROCKFISH RD
Second Line :
City : RAEFORD
State : NC
Zip : 28376-6131
Country : US
Telephone Number : 910-584-6739
Fax Number : 833-260-0543
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2013
Last Update Date : 03/10/2021

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