Provider Demographics
NPI:1467791186
Name:CHARLES, KELLY LOUISE (MSW, LCSW, CSOTS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LOUISE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MSW, LCSW, CSOTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 EAST BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5876
Mailing Address - Country:US
Mailing Address - Phone:866-736-6408
Mailing Address - Fax:980-225-0506
Practice Address - Street 1:1235 EAST BLVD STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5876
Practice Address - Country:US
Practice Address - Phone:866-736-6408
Practice Address - Fax:980-225-0506
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0086791041C0700X
CALCSW1178861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical