Provider Demographics
NPI:1609450535
Name:PRIEST, KELLY M (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:PRIEST
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 POMONA W APT 6
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2980
Mailing Address - Country:US
Mailing Address - Phone:410-258-5726
Mailing Address - Fax:
Practice Address - Street 1:4 POMONA W APT 6
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2980
Practice Address - Country:US
Practice Address - Phone:410-258-5726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD219081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical