Individual
CRYSTAL DIANNE KELLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
525 MOYE BLVD, GREENVILLE, NC 27834-2849
(252) 744-1406
(252) 744-4270
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
24703
NC
1041C0700X
Clinical Social Worker
Primary
C013218
NC
Other
Enumeration date
07/14/2019
Last updated
06/18/2025
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