Healthcare Provider Details

I. General information

NPI: 1285177196
Provider Name (Legal Business Name): KELSEY RAVINDRAN M.A., L.P.C.-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2016
Last Update Date: 11/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 GADSDEN ST SUITE 204
COLUMBIA SC
29201-6400
US

IV. Provider business mailing address

1401 HAMPTON ST UNIT 511
COLUMBIA SC
29201-3386
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-9767
  • Fax:
Mailing address:
  • Phone: 803-254-9767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6500
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: