1326778424 NPI number — SELINA KELLY COUNSELING, PLLC

Table of content: (NPI 1326778424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326778424 NPI number — SELINA KELLY COUNSELING, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SELINA KELLY COUNSELING, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326778424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 BRIAR BROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLACK MOUNTAIN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28711-3703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-922-4663
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 CENTREPARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28805-1265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-518-6560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
SELINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
802-922-4663

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1891464640 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".