Individual
MRS. KILEY COSTNER THIEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHCS
Contact information
Practice address
1501 E 7TH ST STE 6, CHARLOTTE, NC 28204-2455
(704) 756-3623
Mailing address
1501 E 7TH ST STE 6, CHARLOTTE, NC 28204-2455
(704) 756-3623
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5150
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6103051
—
NC
Enumeration date
07/10/2006
Last updated
09/25/2020
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