Healthcare Provider Details

I. General information

NPI: 1023609294
Provider Name (Legal Business Name): KEELAND KELLEY LODATO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 JOHN ST STE 3B
GREER SC
29651-1463
US

IV. Provider business mailing address

837 BARNUM CT
GREER SC
29651-7572
US

V. Phone/Fax

Practice location:
  • Phone: 704-807-6555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16306
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11618
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: