Provider Demographics
NPI:1316737943
Name:KELLY, COLBY LAINE (LCSW)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:LAINE
Last Name:KELLY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 SPRINGACRES COVE
Mailing Address - Street 2:COLBYKELLYONE@GMAIL.COM
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578
Mailing Address - Country:US
Mailing Address - Phone:850-842-1314
Mailing Address - Fax:
Practice Address - Street 1:4591 E HIGHWAY 20 STE 202I
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8845
Practice Address - Country:US
Practice Address - Phone:850-918-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW230021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical