Provider Demographics
NPI:1295996056
Name:KELLY, CALVIN ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:ANDREW
Last Name:KELLY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CAPTAINS DR
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9211
Mailing Address - Country:US
Mailing Address - Phone:828-231-5986
Mailing Address - Fax:
Practice Address - Street 1:37 CAPTAINS DR
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-9211
Practice Address - Country:US
Practice Address - Phone:828-231-5986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health