Individual
KIERSTAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4975 LACROSS RD STE 351, NORTH CHARLESTON, SC 29406-6530
(803) 403-0294
Mailing address
PO BOX 748465, ATLANTA, GA 30374-8465
(855) 284-7483
(617) 807-0958
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
17984
SC
Other
Enumeration date
08/04/2025
Last updated
08/04/2025
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