Individual
MRS. ANTOINETTE MARY KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
12607 CLARK MEADOWS CT, CLARKSBURG, MD 20871-4000
(240) 498-1648
Mailing address
1620 ELTON RD, SUITE 204, SILVER SPRING, MD 20903-1740
(301) 439-7191
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC2067
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143850
MAMSI
MD
01
—
7539782
AETNA
MD
01
—
F127-0028
BLUE CROSS BLUE SHIELD
DC
01
—
LV12/647371-01
BLUE CROSS BLUE SHIELD
MD
Enumeration date
11/01/2006
Last updated
07/09/2007
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