Provider Demographics
NPI:1902949878
Name:KELLEY, MARK ANDREW (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
Last Name:KELLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4825
Mailing Address - Country:US
Mailing Address - Phone:336-887-7350
Mailing Address - Fax:336-887-7353
Practice Address - Street 1:405 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4325
Practice Address - Country:US
Practice Address - Phone:336-887-7350
Practice Address - Fax:336-887-7353
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13323OtherBCBS PRIVATE INSURANCE
NC6102011Medicaid
NCC5330OtherMEDCOST PRIVATE INSURANCE