Provider Demographics
NPI:1891464640
Name:KELLY, SELINA (LCMHC)
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BRIAR BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-3703
Mailing Address - Country:US
Mailing Address - Phone:802-922-4663
Mailing Address - Fax:
Practice Address - Street 1:1000 CENTREPARK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1265
Practice Address - Country:US
Practice Address - Phone:828-518-6560
Practice Address - Fax:828-829-8319
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health