Basic Information
| Provider Information | |||||||||
| NPI: | 1164503348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLAGHER-KILEY | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1033 EDGEFIELD STREET | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296463205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642273908 | ||||||||
| FaxNumber: | 8642272668 | ||||||||
| Practice Location | |||||||||
| Address1: | 1033 EDGEFIELD ST | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296463205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642273908 | ||||||||
| FaxNumber: | 8642272668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 9210 | SC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.