Individual
PATRICK C KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDCIII, QMHS
Contact information
Practice address
225 CARLTON DAVIDSON LN, COAL GROVE, OH 45638-2924
(740) 533-0648
(740) 353-1662
Mailing address
901 WASHINGTON ST, PORTSMOUTH, OH 45662-3944
(740) 354-7702
(740) 353-1662
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C.2305166-TRNE
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCIII.162407
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0361745
—
OH
Enumeration date
04/23/2018
Last updated
09/05/2023
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