Provider Demographics
NPI:1689294670
Name:HARVEY-JONES, KELLY (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HARVEY-JONES
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 1:228 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8127
Mailing Address - Country:US
Mailing Address - Phone:704-654-0226
Mailing Address - Fax:
Practice Address - Street 1:11330 VANSTORY DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8143
Practice Address - Country:US
Practice Address - Phone:704-268-9297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty