Healthcare Provider Details

I. General information

NPI: 1992585822
Provider Name (Legal Business Name): KRISTA HUSSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CLARK SUMMIT DR STE 103
BLUFFTON SC
29910-4200
US

IV. Provider business mailing address

77 BAHR MILL LN
BLUFFTON SC
29909-7857
US

V. Phone/Fax

Practice location:
  • Phone: 843-473-8213
  • Fax: 843-582-0261
Mailing address:
  • Phone: 201-220-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12014
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: