Individual
MS. NICOLE SHAVON KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
11 MISTY WOOD CIR APT H, TIMONIUM, MD 21093-1338
(443) 949-2008
Mailing address
PO BOX 20093, TOWSON, MD 21284-0093
(443) 949-2008
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
171W00000X
Contractor
—
—
172V00000X
Community Health Worker
—
—
225400000X
Rehabilitation Practitioner
—
—
253Z00000X
In Home Supportive Care Agency
—
—
372600000X
Adult Companion
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
06/02/2017
Last updated
07/21/2022
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