Individual
ANGELA DIANE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM, CACD CANADETE
Contact information
Practice address
306 SW 8TH ST, CORVALLIS, OR 97333-4543
(541) 753-2230
Mailing address
306 SW 8TH ST, CORVALLIS, OR 97333-4543
(541) 753-2230
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-18-149
OR
Other
Enumeration date
06/15/2018
Last updated
06/15/2018
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