Provider Demographics
NPI:1982242764
Name:KELLY, JOYCE MELINDA (LMSW)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:MELINDA
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 1:135 FIONA WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21758-8911
Mailing Address - Country:US
Mailing Address - Phone:443-562-4169
Mailing Address - Fax:
Practice Address - Street 1:8181 MAIN STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:757-651-3001
Practice Address - Fax:757-222-3833
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD256411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical