Provider Demographics
NPI:1821323338
Name:SKALA, KELLY LYN (LPC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:LYN
Last Name:SKALA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:LYN
Other - Last Name:MCKILLIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 EAGLE TRL
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-9305
Mailing Address - Country:US
Mailing Address - Phone:402-416-0429
Mailing Address - Fax:252-638-3687
Practice Address - Street 1:1404 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4629
Practice Address - Country:US
Practice Address - Phone:252-638-9091
Practice Address - Fax:252-638-3687
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional