Provider Demographics
NPI:1639363450
Name:CANTER, KELLEY DIXON (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:DIXON
Last Name:CANTER
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 FAIRFAX RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3009
Mailing Address - Country:US
Mailing Address - Phone:336-420-1616
Mailing Address - Fax:
Practice Address - Street 1:2100 FAIRFAX RD
Practice Address - Street 2:SUITE 203
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3009
Practice Address - Country:US
Practice Address - Phone:336-420-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6713101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor