Provider Demographics
NPI:1861472144
Name:MCCONNELL, BETTY KELLEY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:KELLEY
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:BETTY
Other - Middle Name:FRANCES
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:3600 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-7747
Mailing Address - Country:US
Mailing Address - Phone:843-743-7512
Mailing Address - Fax:843-743-7521
Practice Address - Street 1:3600 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7747
Practice Address - Country:US
Practice Address - Phone:843-743-7512
Practice Address - Fax:843-743-7521
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health