Provider Demographics
NPI:1134490923
Name:SCHNEIDER, KELLY ELYSSE (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ELYSSE
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELYSSE
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1261
Mailing Address - Fax:704-384-3145
Practice Address - Street 1:1401 MATTHEWS TOWNSHIP PKWY STE 320
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-384-1261
Practice Address - Fax:704-384-3145
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9153101YP2500X
NCA9153101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor