Provider Demographics
NPI:1942785589
Name:SEALEY, KRISTEN YAKIRA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:YAKIRA
Last Name:SEALEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 UNIVERSITY CITY BLVD
Mailing Address - Street 2:STE A3, 145
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213
Mailing Address - Country:US
Mailing Address - Phone:980-202-1344
Mailing Address - Fax:980-447-5611
Practice Address - Street 1:8640 UNIVERSITY CITY BLVD
Practice Address - Street 2:STE A3, 145
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213
Practice Address - Country:US
Practice Address - Phone:980-202-1344
Practice Address - Fax:980-447-5611
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-29
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0146571041C0700X
NCP0129351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty