Provider Demographics
NPI:1134285174
Name:CHILDRESS, KELLY MCGINITY (MED, NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MCGINITY
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:MCGINITY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 SUGAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3023
Mailing Address - Country:US
Mailing Address - Phone:864-593-0309
Mailing Address - Fax:
Practice Address - Street 1:220 SUGAR CREEK RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-3023
Practice Address - Country:US
Practice Address - Phone:864-593-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4936101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid
SC301100Medicaid