Veronica Kelly, LCSW, LCAS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C010275 Issued in NC

Practice address

203 S Main St
Spring Lake, NC 28390-3902

Phone

(910) 261-1116

Fax

(910) 426-0216

NPI assigned

Jul 23, 2014

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kelly Counseling Center

  • Community/Behavioral Health Agency
  • Fayetteville, NC
  • NPI 1154043396

  Clinical

  NPD (past)

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

{
    "created_epoch": "1406073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493251200000",
    "number": "1467860437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 AUBURN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283069353",
            "telephone_number": "910-261-1116",
            "fax_number": "910-426-0216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 S MAIN ST",
            "city": "SPRING LAKE",
            "state": "NC",
            "postal_code": "283903902",
            "telephone_number": "910-261-1116",
            "fax_number": "910-426-0216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "VERONICA",
        "credential": "LCSW, LCAS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-23",
        "last_updated": "2017-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C010275",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NC",
            "license": "C010275",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-20963",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deshayla Jurgens
• Tierra Lynette Kaiser, RBT
• Kaleo Support, Inc.
• Kaleo Supports, Inc. (Phoenix Day Supports)
• Neeti Kapur, M.D.
• Daisa Kemp
• Kidzcare Pediatrics, PC
• Sara Killam, RBT
• Paul Kim, DMD
• James Clifford Kirk, D.D.S.

• Clinical Social Worker in Spring Lake, NC
• Providers in Spring Lake, 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 27, 2017; 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.