Provider Demographics
NPI:1356678130
Name:PHELPS, KELLY ANN (LCMHCS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LOWER STECOAH RD
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28771-9209
Mailing Address - Country:US
Mailing Address - Phone:828-545-3945
Mailing Address - Fax:833-419-0181
Practice Address - Street 1:110 N CORCORAN ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-5015
Practice Address - Country:US
Practice Address - Phone:323-205-7088
Practice Address - Fax:833-419-0181
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS7586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104536Medicaid
NC168CYOtherBCBS