Provider Demographics
NPI:1114669926
Name:KELLUM, CARVEL
Entity Type:Individual
Prefix:
First Name:CARVEL
Middle Name:
Last Name:KELLUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 POST OFFICE SQ
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3206
Mailing Address - Country:US
Mailing Address - Phone:508-822-4027
Mailing Address - Fax:508-822-8257
Practice Address - Street 1:5 POST OFFICE SQ
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3206
Practice Address - Country:US
Practice Address - Phone:508-822-4027
Practice Address - Fax:508-822-8257
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health