MRS. KELLY WAGGONER LPCC
NPI 1730501511
Counselor - Mental Health in Lilburn, GA

Q: What is Kelly Waggoner's NPI number?

The NPI number for Kelly Waggoner is 1730501511. It was assigned to this individual provider in the NPPES registry on January 13, 2014.

Q: What is Kelly Waggoner's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Waggoner was last updated on July 20, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 13, 2014

5165 BOWERS BROOK DR SW, LILBURN, GA 30047(505) 695-1613 Get Directions Write a Review

NPPES record last updated: July 20, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 20, 2020, Dec 27, 2016 (2 updates tracked since 2016).

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About Mrs. Kelly Waggoner Lpcc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. KELLY WAGGONER LPCC (NPI 1730501511) is an individual mental health provider in Lilburn, Georgia, licensed in New Mexico (CCHM0207621) and active in the NPI registry since January 2014. She maintains a secondary practice location in Albuquerque.

NPPES Registry Identity

NPI1730501511

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameMRS. KELLY WAGGONERCredential: LPCC

Location Address5165 BOWERS BROOK DR SWLilburn, GA 30047-5172

Mailing Address5165 Bowers Brook Dr SwLilburn, GA 30047-5172 · (505) 695-1613

Phone(505) 695-1613

Sole ProprietorYes

Enumeration DateJanuary 13, 2014

Last NPPES UpdateJuly 20, 20202 updates tracked since enumeration

NPPES CertifiedJuly 20, 2020

✔ NPI 1730501511 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in NM · CCHM0207621

5165 BOWERS BROOK DR SW, Lilburn, GA 30047

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Secondary Practice Location 1

Location 111005 Spain Rd NE Ste 21Albuquerque, NM 87111-1871 · Phone (505) 695-1613

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Waggoner's NPI number?

The NPI number for Kelly Waggoner is 1730501511. It was assigned to this individual provider in the NPPES registry on January 13, 2014.

Where is Kelly Waggoner located?

Kelly Waggoner practices at 5165 Bowers Brook Dr SW, Lilburn, GA 30047. The listed phone number is (505) 695-1613.

What is Kelly Waggoner's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Kelly Waggoner was last updated on July 20, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.