Provider Demographics
NPI:1588099139
Name:KELLY, WHITNEY DEANN (LMSW)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:DEANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 GARDNER RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5712
Mailing Address - Country:US
Mailing Address - Phone:843-693-8093
Mailing Address - Fax:
Practice Address - Street 1:1064 GARDNER RD STE 204
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5712
Practice Address - Country:US
Practice Address - Phone:843-693-8093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10057104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker