Provider Demographics
NPI:1811878119
Name:KELLY, ALEXUS FREEDOM
Entity type:Individual
Prefix:
First Name:ALEXUS
Middle Name:FREEDOM
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 SOUND RD STE 305
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-7813
Mailing Address - Country:US
Mailing Address - Phone:910-803-2400
Mailing Address - Fax:910-803-2401
Practice Address - Street 1:325 SOUND RD STE 305
Practice Address - Street 2:
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-7813
Practice Address - Country:US
Practice Address - Phone:910-803-2400
Practice Address - Fax:910-803-2401
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician