Provider Demographics
NPI:1558490318
Name:KILEY, JANICE EILEEN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:EILEEN
Last Name:KILEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17915 GOLDEN MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7870
Mailing Address - Country:US
Mailing Address - Phone:704-896-8901
Mailing Address - Fax:
Practice Address - Street 1:196 OLD STAGECOACH LN
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1594
Practice Address - Country:US
Practice Address - Phone:631-806-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0063501041C0700X
NY067431104100000X
NCB000617104100000X
NCP0039321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker