Healthcare Provider Details

I. General information

NPI: 1316347727
Provider Name (Legal Business Name): KRISTI CLEMENTS MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LADY ST
COLUMBIA SC
29201-3402
US

IV. Provider business mailing address

1500 LADY ST
COLUMBIA SC
29201-3402
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-1995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5750
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: