Healthcare Provider Details

I. General information

NPI: 1750456992
Provider Name (Legal Business Name): KIMBERLY SHAY LITTON-BELCHER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 463 BOX 92
KATTERBACH GERMANY
APO AE 09177
DE

IV. Provider business mailing address

920 ALEPPO DR
LADSON SC
29456-3114
US

V. Phone/Fax

Practice location:
  • Phone: 843-469-7120
  • Fax:
Mailing address:
  • Phone: 843-963-6605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178004324
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.007662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: