MEDICARE: KELLEY WEST LCSW

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	104100000X	Social Worker	MSW010330	GA
2	1041C0700X	Clinical Social Worker	CSW009685	GA

General Provider Information

NPI Number	:	1902561012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY WEST LCSW

Provider Business Mailing Address
First Line	:	911 DULUTH HIGHWAY
Second Line	:	# C-1B-315
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043
Country	:	US
Telephone Number	:	404-496-8621
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 DULUTH HIGHWAY
Second Line	:	# C-1B-315
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043
Country	:	US
Telephone Number	:	404-496-8621
Fax Number	:

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

Provider Enumeration Date	:	11/03/2021
Last Update Date	:	04/09/2026

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Directions to “ KELLEY WEST LCSW” Practice Location

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