Provider Demographics
NPI:1598140873
Name:BALL, KELSIE ERIN BIRCH (LCSW)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:ERIN BIRCH
Last Name:BALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 CHESTNUT FALLS RD
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-6873
Mailing Address - Country:US
Mailing Address - Phone:919-819-5122
Mailing Address - Fax:
Practice Address - Street 1:8325 US 70 BUS HWY W STE A2
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-4856
Practice Address - Country:US
Practice Address - Phone:919-550-4910
Practice Address - Fax:919-550-6870
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0163431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical