Individual
KELLY A SALLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCADC, CPRS, CCTP
Contact information
Practice address
14 HILSINGER RD # 240, MOUNT TABOR, NJ 07878-9226
(973) 404-0214
Mailing address
PO BOX 240, MOUNT TABOR, NJ 07878-0240
(973) 404-0214
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
37LC00331800
NJ
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37LC00331800
NJ
Other
Enumeration date
08/15/2021
Last updated
08/15/2021
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