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NPI Code Detail

MEDICARE: MRS. BETTY KELLEY MCCONNELL LCSW

MEDICARE:  MRS. BETTY KELLEY MCCONNELL  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor1098TN

General Provider Information

NPI Number : 1861472144
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETTY KELLEY MCCONNELL LCSW
Provider Business Mailing Address
First Line : 3600 RIVERS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29405-7747
Country : US
Telephone Number : 843-743-7512
Fax Number : 843-743-7521
Provider Business Practice Location Address
First Line : 3600 RIVERS AVE
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29405-7747
Country : US
Telephone Number : 843-743-7512
Fax Number : 843-743-7521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. BETTY KELLEY MCCONNELL LCSW” Practice Location

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