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Individual
SEAN KELLY
Active
Individual
SEAN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC I, CRM
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20-07-07
OR
175T00000X
Peer Specialist
16-CRM-008
OR
Other
Enumeration date
02/09/2016
Last updated
08/11/2020
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