Provider Demographics
NPI:1538745724
Name:MEHALIC, KELLI (LCMHC, NCC)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:MEHALIC
Suffix:
Gender:F
Credentials:LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KURALT HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6702
Mailing Address - Country:US
Mailing Address - Phone:801-367-4482
Mailing Address - Fax:
Practice Address - Street 1:421 S SHARON AMITY RD STE 4C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2840
Practice Address - Country:US
Practice Address - Phone:980-243-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16368101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional