Provider Demographics
NPI:1578313573
Name:KELLOGG, HAROLD FIELD III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:FIELD
Last Name:KELLOGG
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 JULIA CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5124
Mailing Address - Country:US
Mailing Address - Phone:910-581-8764
Mailing Address - Fax:
Practice Address - Street 1:205 JULIA CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5124
Practice Address - Country:US
Practice Address - Phone:910-581-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCO0027461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical