Provider Demographics
NPI:1619370772
Name:KELLEY, LISA CHRISTINE (MA, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CHRISTINE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13420 REESE BLVD W
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7925
Mailing Address - Country:US
Mailing Address - Phone:704-266-4208
Mailing Address - Fax:
Practice Address - Street 1:13420 REESE BLVD W
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7925
Practice Address - Country:US
Practice Address - Phone:704-266-4208
Practice Address - Fax:866-876-6809
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional