Organization
THE KELLY CODE, LLC
Active
Other names
The Kelly Code
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM J KELLY LCAS (OWNER)
(252) 412-1963
Entity
Organization
Contact information
Practice address
3219 LANDMARK ST STE B, GREENVILLE, NC 27834-7688
(252) 412-1963
Mailing address
205 WESTWOOD DR, GREENVILLE, NC 27834-5015
(252) 412-1963
(252) 364-2248
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730457193
—
NC
Enumeration date
11/19/2018
Last updated
11/19/2018
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