Provider Demographics
NPI:1366905648
Name:KEARNS, KELLEY MARIE (LPC)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:MARIE
Last Name:KEARNS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:MARIE
Other - Last Name:THORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:188 N FOSTER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4568
Mailing Address - Country:US
Mailing Address - Phone:334-792-1452
Mailing Address - Fax:334-792-1791
Practice Address - Street 1:188 N FOSTER ST STE 101
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4568
Practice Address - Country:US
Practice Address - Phone:334-792-1452
Practice Address - Fax:334-792-1791
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional