Individual
SHNELLA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFTA
Contact information
Practice address
1100 LOGGER CT, SUITE C-100, RALEIGH, NC 27609-8525
(919) 844-7770
Mailing address
1100 LOGGER CT, SUITE C-100, RALEIGH, NC 27609-8525
(919) 844-7770
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
10044A
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13557311
CAQH PROVIDER ID
NC
Enumeration date
06/30/2015
Last updated
06/30/2015
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