Provider Demographics
NPI:1952966681
Name:DUSEK, KELLY SANDERS (LPC, LCMHC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:SANDERS
Last Name:DUSEK
Suffix:
Gender:F
Credentials:LPC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15812 WALNUT HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-5010
Mailing Address - Country:US
Mailing Address - Phone:704-641-3824
Mailing Address - Fax:
Practice Address - Street 1:15812 WALNUT HILL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-5010
Practice Address - Country:US
Practice Address - Phone:803-542-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7006101YP2500X
NC101YS0200X
SC101YS0200X
NC19794101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool