Provider Demographics
NPI:1750620779
Name:DAVIS, KERI GUEST (MA, LPC, LPC/S, LAC)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:GUEST
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LPC, LPC/S, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 RUBY RD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-2407
Mailing Address - Country:US
Mailing Address - Phone:843-942-9597
Mailing Address - Fax:843-326-4816
Practice Address - Street 1:1629 RUBY RD
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-2407
Practice Address - Country:US
Practice Address - Phone:843-942-9597
Practice Address - Fax:843-326-4816
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5651101YM0800X, 101YP2500X
SC565101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1374Medicaid