Provider Demographics
NPI:1417421777
Name:KERNESS, DEBRA LIANA (LISW-CP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LIANA
Last Name:KERNESS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 ROUSTABOUT WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-8054
Mailing Address - Country:US
Mailing Address - Phone:843-991-9720
Mailing Address - Fax:
Practice Address - Street 1:100-A CENTRAL AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445
Practice Address - Country:US
Practice Address - Phone:843-991-9720
Practice Address - Fax:877-780-1103
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC88311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical