Healthcare Provider Details

I. General information

NPI: 1598305138
Provider Name (Legal Business Name): KG PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2020
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 KING ST
CHARLESTON SC
29403-3427
US

IV. Provider business mailing address

1166 KING ST
CHARLESTON SC
29403-3427
US

V. Phone/Fax

Practice location:
  • Phone: 843-410-3165
  • Fax:
Mailing address:
  • Phone: 843-410-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KRISTI GALLOWAY
Title or Position: OWNER
Credential: MA, LPC-S
Phone: 843-410-3165