Provider Demographics
NPI:1306513361
Name:LIPSEY, KELLI (LCSWA)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:LIPSEY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 REMOUNT RD STE C1
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6459
Mailing Address - Country:US
Mailing Address - Phone:704-284-7244
Mailing Address - Fax:
Practice Address - Street 1:125 REMOUNT RD STE C1
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6459
Practice Address - Country:US
Practice Address - Phone:704-284-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0158331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical