Provider Demographics
NPI:1043465867
Name:KELLY, CHRISTINE ELIZABETH (MS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 CHURCH ST. NORTH
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4300
Mailing Address - Country:US
Mailing Address - Phone:704-262-1320
Mailing Address - Fax:704-262-1322
Practice Address - Street 1:845 CHURCH ST N
Practice Address - Street 2:SUITE 305
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4300
Practice Address - Country:US
Practice Address - Phone:704-262-1320
Practice Address - Fax:704-262-1322
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health