Provider Demographics
NPI:1114618121
Name:MCCALL, KELLY LOUANN (LCMHCA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LOUANN
Last Name:MCCALL
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 AUDREY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7269
Mailing Address - Country:US
Mailing Address - Phone:980-484-2111
Mailing Address - Fax:
Practice Address - Street 1:2925 AUDREY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7269
Practice Address - Country:US
Practice Address - Phone:980-484-2111
Practice Address - Fax:704-259-0480
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health