Healthcare Provider Details

I. General information

NPI: 1396952727
Provider Name (Legal Business Name): LAURA ANNE ESTUPINAN-KANE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 WEST HILL BLVD JOINT BASE CHARLESTON
CHARLESTON SC
29404
US

IV. Provider business mailing address

132 WHITEMARSH CT
MURRELLS INLET SC
29576-7980
US

V. Phone/Fax

Practice location:
  • Phone: 843-963-6548
  • Fax:
Mailing address:
  • Phone: 443-622-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number03853
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number03853
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: