Provider Demographics
NPI:1326597840
Name:KELLEHER, JOY (LCSW)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 GREEN ST NW
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3349
Mailing Address - Country:US
Mailing Address - Phone:470-410-8861
Mailing Address - Fax:
Practice Address - Street 1:431 GREEN ST NW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3349
Practice Address - Country:US
Practice Address - Phone:470-410-8861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0030731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical