Provider Demographics
NPI:1790521615
Name:KELLY, PATRICIA LEE (LMSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:LEE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1924C DAUPHIN ISLAND PKWY # NA
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36605-3004
Mailing Address - Country:US
Mailing Address - Phone:251-476-5733
Mailing Address - Fax:251-470-7249
Practice Address - Street 1:1924C DAUPHIN ISLAND PKWY # NA
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36605-3004
Practice Address - Country:US
Practice Address - Phone:251-476-5733
Practice Address - Fax:251-470-7249
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4967G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker