Provider Demographics
NPI:1235976283
Name:MCKENNA, KELLY O'BRIEN (LCSWA, MSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:O'BRIEN
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:LCSWA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BATTLEGROUND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2107
Mailing Address - Country:US
Mailing Address - Phone:336-337-5469
Mailing Address - Fax:336-660-2563
Practice Address - Street 1:1611 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2888
Practice Address - Country:US
Practice Address - Phone:415-254-6239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0209561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical