Healthcare Provider Details

I. General information

NPI: 1518834449
Provider Name (Legal Business Name): KELSEY WILKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N PINE ST
ABERDEEN NC
28315-2732
US

IV. Provider business mailing address

146 MAPLE ST
ROCKINGHAM NC
28379-5043
US

V. Phone/Fax

Practice location:
  • Phone: 910-944-2189
  • Fax: 910-944-7443
Mailing address:
  • Phone: 910-206-7533
  • Fax: 910-944-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-29559
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: