Provider Demographics
NPI:1366809097
Name:PLACE, KAILEE (LPC)
Entity type:Individual
Prefix:
First Name:KAILEE
Middle Name:
Last Name:PLACE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 EALLYSTOCKERT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6137
Mailing Address - Country:US
Mailing Address - Phone:843-633-2622
Mailing Address - Fax:
Practice Address - Street 1:22 WINDERMERE BLVD STE B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7492
Practice Address - Country:US
Practice Address - Phone:843-633-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6211101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor