Provider Demographics
NPI:1740058288
Name:WILSON, KELSI (LMFT)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KELSI
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5950 FAIRVIEW RD STE 700
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-0085
Mailing Address - Country:US
Mailing Address - Phone:980-255-5335
Mailing Address - Fax:
Practice Address - Street 1:5950 FAIRVIEW RD STE 700
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0085
Practice Address - Country:US
Practice Address - Phone:980-255-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2480106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist