Healthcare Provider Details

I. General information

NPI: 1487393229
Provider Name (Legal Business Name): CHLOE PAULSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19901 W CATAWBA AVE STE 102
CORNELIUS NC
28031-4040
US

IV. Provider business mailing address

1802 CHAPEL HILLS DR STE A
COLORADO SPRINGS CO
80920-3736
US

V. Phone/Fax

Practice location:
  • Phone: 855-675-4144
  • Fax: 617-807-0958
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18066
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: