Provider Demographics
NPI:1275256836
Name:RHYNE, KELLY BORDEN (LMSW, MDIV)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:BORDEN
Last Name:RHYNE
Suffix:
Gender:F
Credentials:LMSW, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 KENTUCKY ST # 154
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-1124
Mailing Address - Country:US
Mailing Address - Phone:404-500-8992
Mailing Address - Fax:
Practice Address - Street 1:610 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:GA
Practice Address - Zip Code:30079-1124
Practice Address - Country:US
Practice Address - Phone:404-500-8992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0112791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical