Individual
BLAKE JILLIAN KELLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHCA
Contact information
Practice address
6849 FAIRVIEW RD STE 702, CHARLOTTE, NC 28210-3393
(704) 350-5324
(980) 458-6037
Mailing address
6849 FAIRVIEW RD STE 702, CHARLOTTE, NC 28210-3393
(704) 350-5324
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A16773
NC
Other
Enumeration date
10/06/2021
Last updated
08/11/2022
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