Healthcare Provider Details

I. General information

NPI: 1255252920
Provider Name (Legal Business Name): KYRA LEDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E DEKALB ST STE 1
CAMDEN SC
29020-4432
US

IV. Provider business mailing address

18 COULTER PINE CT
COLUMBIA SC
29229-9500
US

V. Phone/Fax

Practice location:
  • Phone: 803-312-4686
  • Fax:
Mailing address:
  • Phone: 254-226-7427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11093
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: