Provider Demographics
NPI:1639983109
Name:KAUFFMAN, SYDNEY ELLESSE (LCMHC-A)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ELLESSE
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:ELLESSE
Other - Last Name:SAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC-A
Mailing Address - Street 1:2728 WINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5269
Mailing Address - Country:US
Mailing Address - Phone:251-424-7768
Mailing Address - Fax:
Practice Address - Street 1:1933 JAKE ALEXANDER BLVD W STE 102
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1157
Practice Address - Country:US
Practice Address - Phone:704-762-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health