Provider Demographics
NPI:1386029585
Name:MEADOWS, KELLICE NICOLE (LCSWA)
Entity Type:Individual
Prefix:
First Name:KELLICE
Middle Name:NICOLE
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8007 N POINT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3268
Mailing Address - Country:US
Mailing Address - Phone:866-700-1606
Mailing Address - Fax:866-338-5921
Practice Address - Street 1:8007 N POINT BLVD STE A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3268
Practice Address - Country:US
Practice Address - Phone:866-700-1606
Practice Address - Fax:866-338-5921
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0155311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1386029585OtherNPI