Provider Demographics
NPI:1235475302
Name:WHITE, KELSEE STEPHENS (MA, LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:KELSEE
Middle Name:STEPHENS
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, LMFTA
Other - Prefix:MS
Other - First Name:KELSEE
Other - Middle Name:RENEE
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFTA
Mailing Address - Street 1:145 SCALEYBARK RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2682
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 SCALEYBARK RD STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2682
Practice Address - Country:US
Practice Address - Phone:704-567-8690
Practice Address - Fax:704-536-6030
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8067A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist