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: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PINCKNEY COLONY RD STE 312
BLUFFTON SC
29909-4148
US

IV. Provider business mailing address

10 PINCKNEY COLONY RD STE 312
BLUFFTON SC
29909-4148
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTIN ANDERSON
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSY.D.
Phone: 843-540-4533