Individual
MRS. KIM J KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS
Contact information
Practice address
200 S POLLOCK ST, SELMA, NC 27576-3062
(919) 965-6770
(919) 965-0196
Mailing address
205 WESTWOOD DR, GREENVILLE, NC 27834-5015
(252) 412-1963
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2526
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2526
NC
101YM0800X
Mental Health Counselor
2526
NC
Other
Enumeration date
12/13/2011
Last updated
02/25/2016
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