Individual
CAROLINE CONN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
309 SCOTTS RIDGE TRL, APEX, NC 27502-6577
(704) 609-4456
Mailing address
309 SCOTTS RIDGE TRL, APEX, NC 27502-6577
(704) 609-4456
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86-2675055
IRS
NC
Enumeration date
10/05/2016
Last updated
08/19/2021
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