Provider Demographics
NPI:1578753463
Name:GOTHARD, KELLY DAY (MS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DAY
Last Name:GOTHARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 RIGBY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2644
Mailing Address - Country:US
Mailing Address - Phone:803-898-1704
Mailing Address - Fax:
Practice Address - Street 1:COLUMBIA AREA MENTAL HEALTH SERVICES
Practice Address - Street 2:2715 COLONIAL DR
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-898-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor