Healthcare Provider Details

I. General information

NPI: 1013891316
Provider Name (Legal Business Name): DEBRA CRISP PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 MCMILLAN ROAD
CLEMSON SC
29634-0001
US

IV. Provider business mailing address

BOX 344054
CLEMSON SC
29634-0001
US

V. Phone/Fax

Practice location:
  • Phone: 864-656-2451
  • Fax: 864-656-0760
Mailing address:
  • Phone: 864-656-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1428
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: