Provider Demographics
NPI:1538842737
Name:FARMER, CHELSEY (MA)
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9336 KINGS PARADE BLVD APT 3138
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5856
Mailing Address - Country:US
Mailing Address - Phone:919-943-1868
Mailing Address - Fax:
Practice Address - Street 1:2828 QUEEN CITY DR STE D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2737
Practice Address - Country:US
Practice Address - Phone:980-299-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health