Healthcare Provider Details

I. General information

NPI: 1063341162
Provider Name (Legal Business Name): KRISTY CISNEROS LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E 1ST AVE
EASLEY SC
29640-3063
US

IV. Provider business mailing address

405 GUTHRIE GROVE CHURCH RD
PELZER SC
29669-9097
US

V. Phone/Fax

Practice location:
  • Phone: 864-835-8409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCOU.10911
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: