Provider Demographics
NPI:1194416685
Name:HERNANDEZ-KELLY, NEIDY M (LPCA, NCC)
Entity type:Individual
Prefix:MRS
First Name:NEIDY
Middle Name:M
Last Name:HERNANDEZ-KELLY
Suffix:
Gender:F
Credentials:LPCA, NCC
Other - Prefix:MS
Other - First Name:NEIDY
Other - Middle Name:M
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCC, MA
Mailing Address - Street 1:961 ROBERTS BRANCH PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9150
Mailing Address - Country:US
Mailing Address - Phone:803-661-4357
Mailing Address - Fax:
Practice Address - Street 1:961 ROBERTS BRANCH PKWY STE 106
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9150
Practice Address - Country:US
Practice Address - Phone:803-661-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional