MEDICARE: KHALIYAH STROUD LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	17938	NC
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1790405488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHALIYAH STROUD LCMHC

Provider Business Mailing Address
First Line	:	228 W EDENTON ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-1714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 W EDENTON ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-1714
Country	:	US
Telephone Number	:	919-374-0057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	03/19/2026

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