MEDICARE: CARLEE COOPER BALSER LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	16546	NC

General Provider Information

NPI Number	:	1255062956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLEE COOPER BALSER LCMHC

Provider Business Mailing Address
First Line	:	200 QUEENS RD STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3257
Country	:	US
Telephone Number	:	704-980-3082
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 QUEENS RD STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3257
Country	:	US
Telephone Number	:	704-980-3082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	06/12/2026

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