Suzanne Autrey Kelly, LPC,LCAS,CEAP

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

1070 Issued in NC

Practice address

110 W Elm St
Yadkinville, NC 27055-1758

Phone

(336) 677-3991

Fax

(336) 677-1359

NPI assigned

Jan 3, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blue Ridge Counseling

  • Professional Counselor
  • Yadkinville, NC
  • NPI 1104239474

  Addiction (Substance Use Disorder)

  NPD (past) Authorized official

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755129600000",
    "number": "1366420192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W ELM ST # 1758",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270558203",
            "telephone_number": "336-466-1053",
            "fax_number": "336-677-1359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W ELM ST",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270551758",
            "telephone_number": "336-677-3991",
            "fax_number": "336-677-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SUZANNE",
        "middle_name": "AUTREY",
        "name_prefix": "Mrs.",
        "credential": "LPC,LCAS,CEAP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-03",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NC",
            "license": "60",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1223",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "1070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6112226",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NORTH CAROLINA",
            "identifier": "1005H",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jodi Province Counseling Services PLLC
• Johnson Enterprises of Shelby Inc
• Ada Johnson
• Sherrill Leigh Jordan, DDS
• Carley Jordan Joyner
• Craig Landon Kester
• Gunnar Easton Key
• Mary Kathryn Brewer Key
• Siva Sankar Krishnan, P.T.A.
• Laboratory Corporation of America Holdings

• All providers in Yadkinville, NC
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.