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Individual
MS. SUSAN KELLY
Active
Individual
MS. SUSAN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC, CAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000634
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000634
LADC
CT
01
—
3734
CAC
CT
Enumeration date
04/14/2008
Last updated
04/14/2008
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