Provider Demographics
NPI:1679779854
Name:WILLIAMS, KELLI PARNELLE (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:PARNELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:ANNE
Other - Last Name:PARNELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:109 BEE STREET (SW - 122)
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-9012
Mailing Address - Country:US
Mailing Address - Phone:843-789-6598
Mailing Address - Fax:
Practice Address - Street 1:109 BEE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5703
Practice Address - Country:US
Practice Address - Phone:843-577-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC88871041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical