Healthcare Provider Details

I. General information

NPI: 1003441007
Provider Name (Legal Business Name): CHELSEA ELIZABETH ETHERIDGE LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 SUNNY HILL LN
MILL SPRING NC
28756-0646
US

IV. Provider business mailing address

324 SUNNY HILL LN
MILL SPRING NC
28756-0646
US

V. Phone/Fax

Practice location:
  • Phone: 828-243-4856
  • Fax:
Mailing address:
  • Phone: 828-243-4856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17874
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: