Provider Demographics
NPI:1841780905
Name:MORRISON, KELLI ANN (CDCA, QMHS)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
Last Name:MORRISON
Suffix:
Gender:F
Credentials:CDCA, QMHS
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ANN
Other - Last Name:ADKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CDCA
Mailing Address - Street 1:517 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-1036
Mailing Address - Country:US
Mailing Address - Phone:740-451-1455
Mailing Address - Fax:740-451-1456
Practice Address - Street 1:517 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-1036
Practice Address - Country:US
Practice Address - Phone:740-451-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.165792171M00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0299747Medicaid