Provider Demographics
NPI:1669908984
Name:KELLY, CHRISTIE (LMSW)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 FAIRWAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8069
Mailing Address - Country:US
Mailing Address - Phone:501-771-8261
Mailing Address - Fax:501-771-8263
Practice Address - Street 1:4701 FAIRWAY AVE
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8066
Practice Address - Country:US
Practice Address - Phone:501-771-8261
Practice Address - Fax:501-771-8263
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8406-M1041S0200X
AR8406-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool