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General NPI Number Information
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NPI Number | 1144795246
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Entity Type | Individual
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Provider Name | TALISHA MONIC KELLY LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 3515 DAVID COX RD UNIT 481321
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City | CHARLOTTE
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State | NC
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Zip | 28269-2537
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Country | US
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Telephone | 704-336-0366
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Fax |
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Provider Business Mailing Address
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Address Line | 635 HILLGROVE LN
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City | GARNER
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State | NC
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Zip | 27529-8385
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Country | US
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Telephone | 919-696-2733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2125
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License Number State | NC
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