Provider Demographics
NPI:1053955187
Name:ADKISSON, KELSIE ANN (MS, CRC, LPCA)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:ANN
Last Name:ADKISSON
Suffix:
Gender:F
Credentials:MS, CRC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 BIRCH RUN DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1464
Mailing Address - Country:US
Mailing Address - Phone:307-286-5632
Mailing Address - Fax:
Practice Address - Street 1:5171 GLENWOOD AVE STE 221
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3266
Practice Address - Country:US
Practice Address - Phone:800-662-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00211221225C00000X
NCA13712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor