Healthcare Provider Details

I. General information

NPI: 1285382697
Provider Name (Legal Business Name): THERAPY WITH KP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 J N PEASE PL STE 202
CHARLOTTE NC
28262-4512
US

IV. Provider business mailing address

10618 NORTHWOODS FOREST DR
CHARLOTTE NC
28214-9607
US

V. Phone/Fax

Practice location:
  • Phone: 704-659-3958
  • Fax:
Mailing address:
  • Phone: 828-447-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAYLA PATTERSON
Title or Position: OWNER/THERAPIST
Credential: LCMHCA
Phone: 828-447-9710