Provider Demographics
NPI:1477199057
Name:HARRIS, KELLY M (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 RUGBY AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-1019
Mailing Address - Country:US
Mailing Address - Phone:678-849-4777
Mailing Address - Fax:
Practice Address - Street 1:2531 BRIARCLIFF RD NE STE 203
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3017
Practice Address - Country:US
Practice Address - Phone:678-849-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health