Healthcare Provider Details

I. General information

NPI: 1336802255
Provider Name (Legal Business Name): CLAIRE KRIETEMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 RUTLEDGE ST STE A
COLUMBIA SC
29204-2520
US

IV. Provider business mailing address

109 ROSE CREEK LN
COLUMBIA SC
29229-8855
US

V. Phone/Fax

Practice location:
  • Phone: 803-380-8870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7790
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: