Healthcare Provider Details

I. General information

NPI: 1790839942
Provider Name (Legal Business Name): KRISTIN DARIUS ANDERSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
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

152 OAKESDALE DR
BLUFFTON SC
29909-7818
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1163
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1163
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: