Healthcare Provider Details

I. General information

NPI: 1710822663
Provider Name (Legal Business Name): KRISTIN ELIZABETH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 ASSEMBLY DR
FORT MILL SC
29708-6400
US

IV. Provider business mailing address

7124 TOPSAIL CIR
FORT MILL SC
29708-8513
US

V. Phone/Fax

Practice location:
  • Phone: 980-292-2743
  • Fax:
Mailing address:
  • Phone: 803-323-9558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10906
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: