Individual
KELLIE BRABHAM WEATHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3310 MAGNOLIA ST, ORANGEBURG, SC 29115-1466
(803) 531-6900
Mailing address
3310 MAGNOLIA ST, ORANGEBURG, SC 29115-1466
(803) 531-6900
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760596480
—
SC
Enumeration date
08/03/2016
Last updated
08/05/2022
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