Provider Demographics
NPI:1417160821
Name:DEAL, KELLY COBLE (MHDL, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:COBLE
Last Name:DEAL
Suffix:
Gender:F
Credentials:MHDL, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WILLOW CREEK DR.
Mailing Address - Street 2:
Mailing Address - City:STANFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:28163
Mailing Address - Country:US
Mailing Address - Phone:704-888-1139
Mailing Address - Fax:704-991-0350
Practice Address - Street 1:150 WILLOW CREEK DR.
Practice Address - Street 2:
Practice Address - City:STANFIELD
Practice Address - State:NC
Practice Address - Zip Code:28163
Practice Address - Country:US
Practice Address - Phone:704-888-1139
Practice Address - Fax:704-991-0350
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC991101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)