Healthcare Provider Details

I. General information

NPI: 1114832771
Provider Name (Legal Business Name): KATELYN HAND
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: KATELYN COKER

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 KATELYN DR
LAKE CITY SC
29560-4458
US

IV. Provider business mailing address

117 KATELYN DR
LAKE CITY SC
29560-4458
US

V. Phone/Fax

Practice location:
  • Phone: 843-373-9022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11142
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: