Provider Demographics
NPI:1821539164
Name:KAHLEIN, MAKEDA (MA LPC)
Entity Type:Individual
Prefix:
First Name:MAKEDA
Middle Name:
Last Name:KAHLEIN
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:SC
Mailing Address - Zip Code:29039-0381
Mailing Address - Country:US
Mailing Address - Phone:803-662-9239
Mailing Address - Fax:
Practice Address - Street 1:469 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115
Practice Address - Country:US
Practice Address - Phone:803-662-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6332101YM0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health