Provider Demographics
NPI:1336864685
Name:SOCKO, KELSEY MARIE (MA, NCC, LCMHC-A)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:SOCKO
Suffix:
Gender:F
Credentials:MA, NCC, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 CARDINAL GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6161
Mailing Address - Country:US
Mailing Address - Phone:919-757-3877
Mailing Address - Fax:919-573-6555
Practice Address - Street 1:3812 ROCKING ROBYN RUN
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8716
Practice Address - Country:US
Practice Address - Phone:919-266-4358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health