Healthcare Provider Details

I. General information

NPI: 1063347656
Provider Name (Legal Business Name): KAYLEE PERRY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 INGLESIDE BLVD
LADSON SC
29456-4142
US

IV. Provider business mailing address

10 S ANDERSON AVE APT A
CHARLESTON SC
29412-3764
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-4200
  • Fax:
Mailing address:
  • Phone: 919-508-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16245
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: