Provider Demographics
NPI:1629146824
Name:KELLY, MEG (LCSW)
Entity Type:Individual
Prefix:
First Name:MEG
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WILDE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1052
Mailing Address - Country:US
Mailing Address - Phone:828-380-2316
Mailing Address - Fax:
Practice Address - Street 1:140 HEALTH CARE LN
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-6350
Practice Address - Country:US
Practice Address - Phone:828-649-9174
Practice Address - Fax:888-649-9161
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0046221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106597Medicaid