Provider Demographics
NPI:1295224897
Name:COUSINO, KELLIE RENEE (MSW,LSW)
Entity type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:RENEE
Last Name:COUSINO
Suffix:
Gender:F
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:RENEE
Other - Last Name:ENGLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 AQUINNAH DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-8277
Mailing Address - Country:US
Mailing Address - Phone:419-217-2122
Mailing Address - Fax:
Practice Address - Street 1:115 AQUINNAH DR
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-8277
Practice Address - Country:US
Practice Address - Phone:419-217-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2203507-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical