Provider Demographics
NPI:1720282411
Name:RIFE, KELLY CRUSE (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CRUSE
Last Name:RIFE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ISLAND VIEW RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-2051
Mailing Address - Country:US
Mailing Address - Phone:704-528-4285
Mailing Address - Fax:704-528-4285
Practice Address - Street 1:107 KILSON DR STE 202
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8183
Practice Address - Country:US
Practice Address - Phone:704-660-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC987101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC71418OtherBCBS