Provider Demographics
NPI:1376914002
Name:TONEY, KELLY (LISW, MSW, CED-S)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TONEY
Suffix:
Gender:F
Credentials:LISW, MSW, CED-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 BUSH RIVER RD STE 5
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5662
Mailing Address - Country:US
Mailing Address - Phone:803-477-3093
Mailing Address - Fax:
Practice Address - Street 1:2800 BUSH RIVER RD STE 5
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5662
Practice Address - Country:US
Practice Address - Phone:803-477-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC110561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical