Provider Demographics
NPI:1316462237
Name:DEPUY, KELLI (LCSWA, MSW)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:DEPUY
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 1:410 N GREENSBORO ST STE 220
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1870
Mailing Address - Country:US
Mailing Address - Phone:919-966-9803
Mailing Address - Fax:
Practice Address - Street 1:106 HILLVIEW ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1418
Practice Address - Country:US
Practice Address - Phone:919-619-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO105551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical