Provider Demographics
NPI:1295211993
Name:HORWOOD, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HORWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 BUSH RIVER RD STE 216
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7537
Mailing Address - Country:US
Mailing Address - Phone:803-851-5252
Mailing Address - Fax:
Practice Address - Street 1:652 BUSH RIVER RD STE 216
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7537
Practice Address - Country:US
Practice Address - Phone:803-851-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13988101YP2500X
SC6858101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty