Provider Demographics
NPI:1679821821
Name:BYRD, KELLI MARIE (MSW, LCSWA)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:MARIE
Last Name:BYRD
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N CIRCLE DR STE E
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2429
Mailing Address - Country:US
Mailing Address - Phone:252-937-3022
Mailing Address - Fax:252-937-3021
Practice Address - Street 1:112 N CIRCLE DR STE E
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2429
Practice Address - Country:US
Practice Address - Phone:252-937-3022
Practice Address - Fax:252-937-3021
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0063871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical