Individual
KELLY O'DONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3705 LATROBE DR, SUITE 340, CHARLOTTE, NC 28211-4824
(704) 364-3989
Mailing address
3705 LATROBE DR, SUITE 340, CHARLOTTE, NC 28211-4824
(704) 364-3989
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-21515
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LCAS-21515
—
NC
Enumeration date
08/18/2015
Last updated
08/18/2015
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