Provider Demographics
NPI:1487162178
Name:CALISSA'S COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:CALISSA'S COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CALISSA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-778-5317
Mailing Address - Street 1:12141 OLD DULIN FARMS WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-5208
Mailing Address - Country:US
Mailing Address - Phone:860-778-5317
Mailing Address - Fax:860-955-4453
Practice Address - Street 1:12141 OLD DULIN FARMS WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-5208
Practice Address - Country:US
Practice Address - Phone:860-778-5317
Practice Address - Fax:860-955-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty