Individual
KENNETH D KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
2309 DEVINE ST, COLUMBIA, SC 29205-2422
(803) 250-1947
Mailing address
2309 DEVINE ST, COLUMBIA, SC 29205-2422
(803) 250-1947
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7756
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3857
NO INSURANCE
—
Enumeration date
03/31/2021
Last updated
08/12/2022
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