Individual
KENYA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
106 S COUNTRY FAIR DR, CHAMPAIGN, IL 61821-3063
(217) 255-3922
Mailing address
106 S COUNTRY FAIR DR, CHAMPAIGN, IL 61821-3063
(217) 255-3922
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
07/24/2025
Last updated
07/24/2025
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