Provider Demographics
NPI:1942924741
Name:BLAIR, KELLI JO (BS)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:JO
Last Name:BLAIR
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:JO
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:835 BIG LICK RD
Mailing Address - Street 2:
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224-8855
Mailing Address - Country:US
Mailing Address - Phone:606-626-0049
Mailing Address - Fax:
Practice Address - Street 1:WILLIAMSON COMPREHENSIVE TREATMENT CENTER INC.
Practice Address - Street 2:1609 WEST THIRD AVENUE
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661
Practice Address - Country:US
Practice Address - Phone:304-235-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)