Provider Demographics
NPI:1710860952
Name:OLIVER, KELLY (LCSW-A)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 MACE RD
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-8826
Mailing Address - Country:US
Mailing Address - Phone:919-923-4597
Mailing Address - Fax:
Practice Address - Street 1:105 E TROLLINGER AVE
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9428
Practice Address - Country:US
Practice Address - Phone:336-899-8800
Practice Address - Fax:336-899-8811
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0224671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical