Healthcare Provider Details

I. General information

NPI: 1851941314
Provider Name (Legal Business Name): SEAGRASS PSYCHOEDUCATIONAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
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

25 CLARK SUMMIT DR STE 103
BLUFFTON SC
29910-4200
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 TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTIN ANDERSON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSY.D.
Phone: 843-473-8213