Individual
JENNIFER KELLNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ADC
Contact information
Practice address
2404 WISE RD, CONWAY, SC 29526-5521
(843) 365-8884
Mailing address
PO BOX 136, CONWAY, SC 29528-0136
(843) 365-8884
(843) 365-6685
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134158231
—
SC
Enumeration date
01/19/2022
Last updated
01/19/2022
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