Healthcare Provider Details

I. General information

NPI: 1649095118
Provider Name (Legal Business Name): EMILY KEY MS, LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 FAIRVIEW ROAD UNIT 700
CHARLOTTE NC
28210
US

IV. Provider business mailing address

5905 FAIRVIEW ROAD UNIT 700
CHARLOTTE NC
28210
US

V. Phone/Fax

Practice location:
  • Phone: 980-255-5335
  • Fax:
Mailing address:
  • Phone: 980-255-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number20298A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: