| NPI | 1760880504 |
|---|---|
| Former Name | HOLLY WADE KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 6138) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 008834) |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2018-03-17 |