Provider Demographics
NPI:1326832056
Name:KELLY, ADARIA
Entity type:Individual
Prefix:
First Name:ADARIA
Middle Name:
Last Name:KELLY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CRANSTON RD
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2656
Mailing Address - Country:US
Mailing Address - Phone:919-440-5412
Mailing Address - Fax:
Practice Address - Street 1:337 BUCKWALTER PLACE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5175
Practice Address - Country:US
Practice Address - Phone:843-212-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health