Provider Demographics
NPI:1477997997
Name:HILL, KELLY GALLAGHER (LPC, CEAP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:GALLAGHER
Last Name:HILL
Suffix:
Gender:F
Credentials:LPC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 GATES ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2509
Mailing Address - Country:US
Mailing Address - Phone:610-213-2397
Mailing Address - Fax:
Practice Address - Street 1:510 GATES ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2509
Practice Address - Country:US
Practice Address - Phone:610-213-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional