Healthcare Provider Details

I. General information

NPI: 1154271450
Provider Name (Legal Business Name): KELLIE GRACE ROGERS LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3971 LITTLE SAVANNAH RD STE 114
CULLOWHEE NC
28723
US

IV. Provider business mailing address

3971 LITTLE SAVANNAH RD STE 114
CULLOWHEE NC
28723
US

V. Phone/Fax

Practice location:
  • Phone: 828-257-4719
  • Fax: 828-820-8329
Mailing address:
  • Phone: 828-257-4719
  • Fax: 828-820-8329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22515
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: