Individual
MS. CAROL ANN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7171 BOWLING DR, 300, SACRAMENTO, CA 95823-2034
(916) 875-0703
Mailing address
7171 BOWLING DR, 300, SACRAMENTO, CA 95823-2034
(916) 875-0703
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171M0000X
171M0000X
CA
Enumeration date
02/15/2013
Last updated
02/15/2013
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