Provider Demographics
NPI:1184318537
Name:MCDONOUGH, KELSEY KATE (LPCA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:KATE
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:KATE
Other - Last Name:WARRINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103B HARTH PL
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8107
Mailing Address - Country:US
Mailing Address - Phone:843-879-3520
Mailing Address - Fax:
Practice Address - Street 1:103B HARTH PL
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8107
Practice Address - Country:US
Practice Address - Phone:843-879-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health