Provider Demographics
NPI:1740862937
Name:GRANT, KELSEY LYNN (MA, LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:GRANT
Suffix:
Gender:F
Credentials:MA, LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11526 TRIBAL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-8959
Mailing Address - Country:US
Mailing Address - Phone:828-782-6715
Mailing Address - Fax:
Practice Address - Street 1:1931 J N PEASE PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4544
Practice Address - Country:US
Practice Address - Phone:910-620-6998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health