Kellin Foundation

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

KELLIN FOUNDATION

Practice address

4010 Walker Ave
Greensboro, NC 27403-1918

Phone

(336) 429-5600

NPI assigned

Sep 16, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kelly GravesNPI 1922381912

Title

President and Ceo

Phone

(336) 429-5600

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Graves, PHD

  • Clinical Psychologist
  • Greensboro, NC
  • NPI 1922381912
  NPD Authorized official
• Ciera Harrison, LCSWA

  • Clinical Social Worker
  • Greensboro, NC
  • NPI 1033097167
  NPD
• Jean Wegger, LCSW-A

  • Clinical Social Worker
  • Greensboro, NC
  • NPI 1568340685
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1104653104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 WALKER AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274031918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 WALKER AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274031918",
            "telephone_number": "336-429-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "913 Third Street",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "27405",
            "country_code": "US",
            "telephone_number": "336-429-5600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KELLIN FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "GRAVES",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "336-429-5600",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michaela Briana Keller
• Ashton Haynes Kelley, APRN
• Nancy Anne Kelley, LPC
• Rachelle Kelley, PHARMD
• Suzanne Marie Kelley, COTA
• Kellin Foundation
• Kellin, PLLC
• Douglas Alan Kellogg, D.D.S.
• Andrew Wayne Kelly, DDS
• Chenay A Kelly

• Community/Behavioral Health Agency in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.