Healthcare Provider Details

I. General information

NPI: 1255904272
Provider Name (Legal Business Name): KELLY RENAE GEERS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N MAIN ST STE 202
DAVIDSON NC
28036-9402
US

IV. Provider business mailing address

624 JAMES ALEXANDER WAY
DAVIDSON NC
28036-7070
US

V. Phone/Fax

Practice location:
  • Phone: 704-564-3955
  • Fax:
Mailing address:
  • Phone: 704-564-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006098
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: