Individual
MRS. KELLY JEAN WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, EDS, LPC
Contact information
Practice address
224 E MAIN ST, LEXINGTON, SC 29072-3546
(803) 808-5222
(803) 957-2042
Mailing address
224 E MAIN ST, LEXINGTON, SC 29072-3546
(803) 808-5222
(803) 957-2042
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2760
SC
Other
Enumeration date
10/19/2006
Last updated
07/08/2007
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