Provider Demographics
NPI:1013793298
Name:FLYNN, KELLEY HAMILTON (LMFTA)
Entity Type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:HAMILTON
Last Name:FLYNN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1646
Mailing Address - Country:US
Mailing Address - Phone:919-909-1558
Mailing Address - Fax:
Practice Address - Street 1:5408 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1646
Practice Address - Country:US
Practice Address - Phone:919-909-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist