Provider Demographics
NPI:1013255983
Name:HERWIG, KELLY (LISW-CP, CAC I, GCDF)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HERWIG
Suffix:
Gender:F
Credentials:LISW-CP, CAC I, GCDF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 STAMPORT CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8455
Mailing Address - Country:US
Mailing Address - Phone:803-351-3652
Mailing Address - Fax:
Practice Address - Street 1:9 STAMPORT CT
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8455
Practice Address - Country:US
Practice Address - Phone:803-351-3652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical