Provider Demographics
NPI:1922558378
Name:KELLY, MORGAN JEWELL (MA)
Entity Type:Individual
Prefix:MISS
First Name:MORGAN
Middle Name:JEWELL
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 KILDAIRE FARM ROAD
Mailing Address - Street 2:SUITE 200, ROOM 9
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4597
Mailing Address - Country:US
Mailing Address - Phone:919-346-4571
Mailing Address - Fax:
Practice Address - Street 1:1140 KILDAIRE FARM ROAD
Practice Address - Street 2:SUITE 200, ROOM 9
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511
Practice Address - Country:US
Practice Address - Phone:919-346-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health