Provider Demographics
NPI:1558585083
Name:DRIGGERS, KERI SPONSELLER (LISW-CP)
Entity type:Individual
Prefix:MRS
First Name:KERI
Middle Name:SPONSELLER
Last Name:DRIGGERS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 TOBIAS GADSON BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4795
Mailing Address - Country:US
Mailing Address - Phone:843-746-5153
Mailing Address - Fax:843-766-8606
Practice Address - Street 1:1483 TOBIAS GADSON BLVD STE 107
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4795
Practice Address - Country:US
Practice Address - Phone:843-745-5153
Practice Address - Fax:843-766-8606
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC64881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1034Medicaid
SCP01078719OtherMEDICARE RAILROAD
SCQ346969195Medicare PIN
SCP01078719OtherMEDICARE RAILROAD