Provider Demographics
NPI:1720139439
Name:BELK, KELLY ORR (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ORR
Last Name:BELK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 SE MAYNARD RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6945
Mailing Address - Country:US
Mailing Address - Phone:919-468-9122
Mailing Address - Fax:919-468-9122
Practice Address - Street 1:1230 SE MAYNARD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6945
Practice Address - Country:US
Practice Address - Phone:919-468-9122
Practice Address - Fax:919-468-9122
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0037831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130FWOtherSTATE OF N C HEALTH PLAN
NC200050320-003OtherCIGNA
NC277541000OtherMAGELLAN
NC200050320OtherAETNA
NC6002460Medicaid
NCA8774OtherMEDCOST PREFERRED
NC216708OtherCIGNA BEHAVIORAL HEALTH
NC130FWOtherBLUE CROSS BLUE SHIELD
NC200050320OtherTRICARE
NCN334DOtherEMPIRE BCBS
200050320OtherMHN
NC2873815AMedicare ID - Type Unspecified