Provider Demographics
NPI:1043638190
Name:CAMAK, KELSI HARPER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELSI
Middle Name:HARPER
Last Name:CAMAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 DAMON DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3304
Mailing Address - Country:US
Mailing Address - Phone:843-230-2084
Mailing Address - Fax:
Practice Address - Street 1:2131 DAMON DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3304
Practice Address - Country:US
Practice Address - Phone:843-230-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6829101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC405127Medicaid
SC3343Medicare PIN