Provider Demographics
NPI:1225339302
Name:TURNER WOOLFORD, KELLY MONIQUE (LCPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MONIQUE
Last Name:TURNER WOOLFORD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 KIWI CT
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4076
Mailing Address - Country:US
Mailing Address - Phone:410-977-5100
Mailing Address - Fax:
Practice Address - Street 1:5310 OLD COURT RD STE 204
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-6201
Practice Address - Country:US
Practice Address - Phone:410-977-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCP4332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health