Basic Information
| Provider Information | |||||||||
| NPI: | 1245889989 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUBBIN | ||||||||
| FirstName: | KELLIANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6802 MCCLEAN BLVD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212347260 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 750 W US HIGHWAY 64 | ||||||||
| Address2: | |||||||||
| City: | MURPHY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 289068115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288370071 | ||||||||
| FaxNumber: | 8288375309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2019 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | P015166 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.