Provider Demographics
NPI:1114512803
Name:CONNELLY, CONSTANCE (LCMHC)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BRADY CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4554
Mailing Address - Country:US
Mailing Address - Phone:910-610-5214
Mailing Address - Fax:844-253-4789
Practice Address - Street 1:114 BRADY CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4554
Practice Address - Country:US
Practice Address - Phone:910-610-5214
Practice Address - Fax:844-253-4789
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty