Organization
MODERN WELLNESS FAMILY COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY KENNEDY PHD, LMFT/S, RPT/S (OWNER)
(864) 680-6152
Entity
Organization
Contact information
Practice address
945 E MAIN ST STE 5, SPARTANBURG, SC 29302-2119
(864) 383-9002
(864) 383-9011
Mailing address
945 E MAIN ST STE 5, SPARTANBURG, SC 29302-2119
(864) 383-9002
(864) 383-9011
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP9435
—
SC
05
—
LT1083
—
SC
Enumeration date
10/25/2019
Last updated
01/22/2024
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