Organization
INTERPEACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. REGINA CASSANDRA KELLY LCSW (OWNER)
(910) 261-5500
Entity
Organization
Contact information
Practice address
2712 FORT BRAGG RD, FAYETTEVILLE, NC 28303-4721
(910) 261-5941
(407) 479-3846
Mailing address
2712 FORT BRAGG RD, FAYETTEVILLE, NC 28303-4721
(910) 261-5941
(407) 479-3846
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
C006537
NC
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
07/26/2011
Last updated
07/26/2011
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