Provider Demographics
NPI:1316299985
Name:KOLODY, KELLY M (LMSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:KOLODY
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48332-0753
Mailing Address - Country:US
Mailing Address - Phone:586-904-1210
Mailing Address - Fax:248-741-6274
Practice Address - Street 1:24715 GLEN ORCHARD DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1729
Practice Address - Country:US
Practice Address - Phone:586-904-1210
Practice Address - Fax:248-741-6274
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010942991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical