Individual
KHYSHA LE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
3815 N TRYON ST, CHARLOTTE, NC 28206-2060
(704) 372-8809
(704) 372-8809
Mailing address
3815 N TRYON ST, CHARLOTTE, NC 28206-2060
(704) 372-8809
(704) 372-0350
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2684
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21286
—
NC
Enumeration date
07/10/2014
Last updated
04/17/2019
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