Provider Demographics
NPI:1407452147
Name:REAMES, KERI (MS, LPES, NCSP)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:REAMES
Suffix:
Gender:F
Credentials:MS, LPES, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-8156
Mailing Address - Country:US
Mailing Address - Phone:843-307-0608
Mailing Address - Fax:
Practice Address - Street 1:720 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:SC
Practice Address - Zip Code:29847-2500
Practice Address - Country:US
Practice Address - Phone:843-307-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103TB0200X
SC4733103TM1800X
SC216224103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities