Provider Demographics
NPI:1679846729
Name:KELLY K. ANTHONY, PHD, PLLC
Entity Type:Organization
Organization Name:KELLY K. ANTHONY, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-794-5501
Mailing Address - Street 1:5015 SOUTHPARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7736
Mailing Address - Country:US
Mailing Address - Phone:919-794-5501
Mailing Address - Fax:919-794-5501
Practice Address - Street 1:5015 SOUTHPARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7736
Practice Address - Country:US
Practice Address - Phone:919-794-5501
Practice Address - Fax:919-794-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3117103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty