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1225444201
KIRK DOUGLAS KELLY
BERKELEY, CA
NPI
1225444201
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2014-07-10
Last Update Date
2014-07-10
Business Address
Mr. KIRK DOUGLAS KELLY
1931 CENTER ST
BERKELEY, CA 94704-1105
Phone number: 408-613-0770
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Mailing Address
Mr. KIRK DOUGLAS KELLY
1931 CENTER ST
BERKELEY, CA 94704-1105
Phone number: 408-613-0770
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