Healthcare Provider Details

I. General information

NPI: 1821910902
Provider Name (Legal Business Name): OLIVIA KISSINGER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CREEKVIEW CT
GREENVILLE SC
29615-4800
US

IV. Provider business mailing address

2489 POOLE RD
GREER SC
29651-5046
US

V. Phone/Fax

Practice location:
  • Phone: 864-609-4108
  • Fax:
Mailing address:
  • Phone: 864-952-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-26-2834132
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: