Healthcare Provider Details

I. General information

NPI: 1255062956
Provider Name (Legal Business Name): CARLEE COOPER BALSER LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLEE MEGAN WETZLER

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 QUEENS RD STE 300
CHARLOTTE NC
28204-3257
US

IV. Provider business mailing address

200 QUEENS RD STE 300
CHARLOTTE NC
28204-3257
US

V. Phone/Fax

Practice location:
  • Phone: 704-980-3082
  • Fax:
Mailing address:
  • Phone: 704-980-3082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16546
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: