Healthcare Provider Details

I. General information

NPI: 1003524091
Provider Name (Legal Business Name): KELSEY MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 MILLSTREAM DR
ROCK HILL SC
29732-3581
US

IV. Provider business mailing address

585 MILLSTREAM DR
ROCK HILL SC
29732-3581
US

V. Phone/Fax

Practice location:
  • Phone: 859-992-7429
  • Fax:
Mailing address:
  • Phone: 704-981-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178022530
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP6105-R
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22379
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10323
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: