Provider Demographics
NPI:1992023139
Name:MOORIN, KELLY HOLLAND (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:HOLLAND
Last Name:MOORIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 UNIVERSITY DR BLDG 700
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3489
Mailing Address - Country:US
Mailing Address - Phone:919-237-1337
Mailing Address - Fax:919-237-1625
Practice Address - Street 1:4705 UNIVERSITY DR BLDG 700
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3489
Practice Address - Country:US
Practice Address - Phone:919-237-1337
Practice Address - Fax:919-237-1625
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0076321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6009139Medicaid
Q40429AOtherMEDICARE PTAN