Healthcare Provider Details

I. General information

NPI: 1124130521
Provider Name (Legal Business Name): KATHRYN K. EASTMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 TIGER GRAND DR
CONWAY SC
29526-7582
US

IV. Provider business mailing address

1420 TIGER GRAND DR
CONWAY SC
29526-7582
US

V. Phone/Fax

Practice location:
  • Phone: 603-664-5432
  • Fax:
Mailing address:
  • Phone: 603-664-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number62
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: