Healthcare Provider Details

I. General information

NPI: 1265343040
Provider Name (Legal Business Name): KELLY A DENIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SAM RITTENBERG BLVD STE 2011
CHARLESTON SC
29407-4631
US

IV. Provider business mailing address

2000 SAM RITTENBERG BLVD STE 2011
CHARLESTON SC
29407-4631
US

V. Phone/Fax

Practice location:
  • Phone: 843-793-2104
  • Fax: 843-654-4850
Mailing address:
  • Phone: 843-793-2104
  • Fax: 843-654-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11122
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: