Provider Demographics
NPI:1770183857
Name:PERKINS, KARLY (MA, LCAS-A, NCC)
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MA, LCAS-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10280 ROSE MEADOW LN UNIT 302
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8797
Mailing Address - Country:US
Mailing Address - Phone:919-802-0228
Mailing Address - Fax:
Practice Address - Street 1:10348 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8507
Practice Address - Country:US
Practice Address - Phone:704-288-1097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26684101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)