Provider Demographics
NPI:1336736206
Name:KELLY, ANGELA (LCMHCA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OAK PLZ STE 208
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3000
Mailing Address - Country:US
Mailing Address - Phone:828-575-9760
Mailing Address - Fax:
Practice Address - Street 1:1 OAK PLZ STE 208
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3000
Practice Address - Country:US
Practice Address - Phone:828-575-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health