Individual
MS. KELLY JEANNE MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
2101 ELM ST N, MENTAL HEALTH, FARGO, ND 58102-2417
(701) 239-3700
(701) 237-2642
Mailing address
406 8TH AVE SW, MANDAN, ND 58554-4029
(701) 663-5454
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1449
ND
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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