Provider Demographics
NPI:1891102968
Name:MANUEL, KELLEY L
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:L
Last Name:MANUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 KELSNEY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8396
Mailing Address - Country:US
Mailing Address - Phone:803-920-9512
Mailing Address - Fax:
Practice Address - Street 1:9367 TWO NOTCH RD STE 219
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6442
Practice Address - Country:US
Practice Address - Phone:803-875-1789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7119101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional