Provider Demographics
NPI:1467791186
Name:CHARLES, KELLY LOUISE (MSW, LCSW, CSOTS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LOUISE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MSW, LCSW, CSOTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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:704-384-9414
Mailing Address - Fax:704-384-5735
Practice Address - Street 1:2589 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092
Practice Address - Country:US
Practice Address - Phone:980-263-0458
Practice Address - Fax:980-225-0537
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0086791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical