Provider Demographics
NPI:1992027189
Name:BRAGG, KAYCE KOZMA (MA, LPC, LAC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KAYCE
Middle Name:KOZMA
Last Name:BRAGG
Suffix:
Gender:F
Credentials:MA, LPC, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8378 MACEDONIA CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-6305
Mailing Address - Country:US
Mailing Address - Phone:803-883-0913
Mailing Address - Fax:
Practice Address - Street 1:8378 MACEDONIA CHURCH RD
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-6305
Practice Address - Country:US
Practice Address - Phone:803-883-0913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6055101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health