Regina Cassandra Kelly, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C006534 Issued in NC

Practice address

803 Stamper Rd Ste G
Fayetteville, NC 28303-4193

Phone

(910) 261-5941

Fax

(910) 550-3803

NPI assigned

Oct 2, 2009

Last updated

Apr 29, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Interpeace

  • Psychiatry Physician
  • Fayetteville, NC
  • NPI 1588942403
  Authorized official Same address or phone
• KV Consultants & Associates Inc

  • Mental Health Counselor
  • Fayetteville, NC
  • NPI 1700856788
  NPD

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

{
    "created_epoch": "1254441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556496000000",
    "number": "1386979763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 FAIRFIELD CIR",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283766607",
            "telephone_number": "910-550-3803",
            "fax_number": "910-550-3803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 STAMPER RD STE G",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283034193",
            "telephone_number": "910-261-5941",
            "fax_number": "910-550-3803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "REGINA",
        "middle_name": "CASSANDRA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-02",
        "last_updated": "2019-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C006534",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005589",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erwin A Kelly, LCMHC
• Kayte Kelly
• Kenderlin Jovan Kelly
• Lance Kelly
• Mary Charlene Kelly, MSW
• Ryan Ashley Kelly
• William Huske Kelly, M.D.
• John M Kelsch Jr., M.D.
• Joshua Kelsen, RBT
• Elizabeth Keltner, LCSWA

• Clinical Social Worker in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; 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.