Provider Demographics
NPI:1447832977
Name:KELLY, QUANITTA LASHAY (BSW, MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:QUANITTA
Middle Name:LASHAY
Last Name:KELLY
Suffix:
Gender:F
Credentials:BSW, MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 DUNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-5817
Mailing Address - Country:US
Mailing Address - Phone:980-234-9377
Mailing Address - Fax:
Practice Address - Street 1:4140 CHERRY ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-2536
Practice Address - Country:US
Practice Address - Phone:866-272-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0159791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical