Provider Demographics
NPI:1063993434
Name:NAIL, KELLY LYNETTE (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNETTE
Last Name:NAIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MADDUX DR
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-9574
Mailing Address - Country:US
Mailing Address - Phone:919-583-7232
Mailing Address - Fax:
Practice Address - Street 1:2719 GRAVES DR STE 5
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4536
Practice Address - Country:US
Practice Address - Phone:919-330-4367
Practice Address - Fax:919-330-4375
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21689101YA0400X
NCP0106191041C0700X
NCC0122441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)