MEDICARE: MS. KELLY REBECCA MCCONKEY MA, LPC, 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
1	101YP2500X	Professional Counselor	8930	NC

General Provider Information

NPI Number	:	1982940904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY REBECCA MCCONKEY MA, LPC, NCC

Provider Business Mailing Address
First Line	:	6026 SIX FORKS RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-3899
Country	:	US
Telephone Number	:	919-848-0132
Fax Number	:	919-848-0277

Provider Business Practice Location Address
First Line	:	6026 SIX FORKS RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-3899
Country	:	US
Telephone Number	:	919-848-0132
Fax Number	:	919-848-0277

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

Provider Enumeration Date	:	12/19/2012
Last Update Date	:	01/06/2014

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