Provider Demographics
NPI:1497112429
Name:HARGROVE, KELSEY (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 SHANNON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3532
Mailing Address - Country:US
Mailing Address - Phone:919-551-5506
Mailing Address - Fax:
Practice Address - Street 1:3616 SHANNON RD STE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3532
Practice Address - Country:US
Practice Address - Phone:919-551-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional