Provider Demographics
NPI:1013474980
Name:BAUGHMAN, KELLEY WILLIAMS (MA, LPCA)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:WILLIAMS
Last Name:BAUGHMAN
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 ALBEMARLE AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1833
Mailing Address - Country:US
Mailing Address - Phone:919-344-9761
Mailing Address - Fax:919-591-0161
Practice Address - Street 1:3200 WAKE FOREST RD STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7451
Practice Address - Country:US
Practice Address - Phone:919-713-0260
Practice Address - Fax:919-591-0161
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14478101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional