Provider Demographics
NPI:1568132124
Name:KELLY, FELICIA NICHOLE (LPA)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:NICHOLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 PEBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6334
Mailing Address - Country:US
Mailing Address - Phone:727-280-3722
Mailing Address - Fax:
Practice Address - Street 1:408 PEBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6334
Practice Address - Country:US
Practice Address - Phone:727-280-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5886103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist