Provider Demographics
NPI:1770133902
Name:KELLEY, LEAH (MA, AADC)
Entity type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MA, AADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CHRISTOPHER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1201
Mailing Address - Country:US
Mailing Address - Phone:304-357-0387
Mailing Address - Fax:
Practice Address - Street 1:900 CHRISTOPHER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1201
Practice Address - Country:US
Practice Address - Phone:304-357-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV06-302101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)