Provider Demographics
NPI:1902916653
Name:KATHERINE T. KELLY, PH.D., LLC
Entity Type:Organization
Organization Name:KATHERINE T. KELLY, PH.D., LLC
Other - Org Name:BRANCHES HOLISTIC HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:336-406-8431
Mailing Address - Street 1:1001 REYNOLDA RD
Mailing Address - Street 2:STOCKTON COTTAGE
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3245
Mailing Address - Country:US
Mailing Address - Phone:336-406-8431
Mailing Address - Fax:336-723-1411
Practice Address - Street 1:1001 REYNOLDA RD
Practice Address - Street 2:STOCKTON COTTAGE
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3245
Practice Address - Country:US
Practice Address - Phone:336-406-8431
Practice Address - Fax:336-723-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2729103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty