Provider Demographics
NPI:1720287360
Name:MOYNAHAN, KELLY CORINNE (MA, CAS, LPA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CORINNE
Last Name:MOYNAHAN
Suffix:
Gender:F
Credentials:MA, CAS, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E ARLINGTON BLVD
Mailing Address - Street 2:PARLIAMENT PLACE, SUITE 7
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 E ARLINGTON BLVD
Practice Address - Street 2:PARLIAMENT PLACE, SUITE 7
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5037
Practice Address - Country:US
Practice Address - Phone:252-227-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist