Healthcare Provider Details

I. General information

NPI: 1497660849
Provider Name (Legal Business Name): KALONJI JEGEDE-ROBERTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 LATROBE DR STE 340
CHARLOTTE NC
28211-4823
US

IV. Provider business mailing address

9506 SADDLE RUN TRL
CHARLOTTE NC
28269-0383
US

V. Phone/Fax

Practice location:
  • Phone: 704-364-3989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA23188
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23188
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: