Individual
DAVID SCOTT KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA,CAADC,MAC,CCS
Contact information
Practice address
101 M 66 N, CHARLEVOIX, MI 49720-9338
(231) 547-1144
(231) 547-4970
Mailing address
101 M 66 N, CHARLEVOIX, MI 49720-9338
(231) 547-1144
(231) 547-4970
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
SA0150013
MI
104100000X
Social Worker
Primary
6802062018
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20151209439760
—
MI
Enumeration date
07/20/2015
Last updated
06/15/2023
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