Individual
MR. KELLY CLEON HENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAS
Contact information
Practice address
3826 BLAND RD, RALEIGH, NC 27609-6239
(919) 740-8428
Mailing address
281 KENTUCKY DR, CLAYTON, NC 27527-6272
(919) 740-8428
(919) 243-1856
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
506
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6111836
—
NC
Enumeration date
03/16/2007
Last updated
11/16/2016
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