Provider Demographics
NPI:1265175848
Name:SAINE, KELLI LAUREN
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:LAUREN
Last Name:SAINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RONNIE CT STE D
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4192
Mailing Address - Country:US
Mailing Address - Phone:843-945-0346
Mailing Address - Fax:
Practice Address - Street 1:220 RONNIE CT STE D
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4192
Practice Address - Country:US
Practice Address - Phone:843-945-0346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health