Healthcare Provider Details

I. General information

NPI: 1487578647
Provider Name (Legal Business Name): KRISTINA BAUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 PENNINGTON RD
FOUNTAIN INN SC
29644-4926
US

IV. Provider business mailing address

1231 PENNINGTON RD
FOUNTAIN INN SC
29644-4926
US

V. Phone/Fax

Practice location:
  • Phone: 864-714-6504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10919
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: