Provider Demographics
NPI:1144364712
Name:KELLEY, AMBER SMOOT (LPC)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:SMOOT
Last Name:KELLEY
Suffix:
Gender:F
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:27262-4325
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:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3134106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86362OtherMEDCAST PRIVATE INSURANCE
NC11937OtherBCBS PRIVATE INSURANCE
NC6102017Medicaid