Provider Demographics
NPI:1336785401
Name:DALRYMPLE, KELLY L (MED, LPCA NCC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:L
Last Name:DALRYMPLE
Suffix:
Gender:F
Credentials:MED, LPCA NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5229 GREENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6519
Mailing Address - Country:US
Mailing Address - Phone:301-467-0682
Mailing Address - Fax:
Practice Address - Street 1:21300 CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8505
Practice Address - Country:US
Practice Address - Phone:704-912-4095
Practice Address - Fax:704-943-0512
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA151100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty