Provider Demographics
NPI:1891927323
Name:GREGORY, KELLY A (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:PLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:242 WOODEN WHEEL LN
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7859
Mailing Address - Country:US
Mailing Address - Phone:912-272-1846
Mailing Address - Fax:
Practice Address - Street 1:1126 COBB RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2607
Practice Address - Country:US
Practice Address - Phone:912-272-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC102031041C0700X
GACSW0039861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical