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Individual

KELSEY L. MAZZOCCO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
403 STONEY LANDING ROAD, MONCKS CORNER, SC 29461-3967
(864) 294-2000
Mailing address
403 STONEY LANDING ROAD, MONCKS CORNER, SC 29461-3967

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2255A2300X
Athletic Trainer
1986
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
435201
SC
Enumeration date
07/25/2016
Last updated
08/18/2022
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