Provider Demographics
NPI:1285177196
Name:RAVINDRAN, KELSEY (MA, LPC-I)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:RAVINDRAN
Suffix:
Gender:F
Credentials:MA, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HAMPTON ST
Mailing Address - Street 2:UNIT 511
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3386
Mailing Address - Country:US
Mailing Address - Phone:803-254-9767
Mailing Address - Fax:
Practice Address - Street 1:1911 GADSDEN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-6400
Practice Address - Country:US
Practice Address - Phone:803-254-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-24
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional