Healthcare Provider Details

I. General information

NPI: 1316873052
Provider Name (Legal Business Name): KRISTIN COZENE LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3691 PALMETTO POINTE BLVD STE 101
MYRTLE BEACH SC
29588-1202
US

IV. Provider business mailing address

3691 PALMETTO POINTE BLVD STE 101
MYRTLE BEACH SC
29588-1202
US

V. Phone/Fax

Practice location:
  • Phone: 843-252-0323
  • Fax:
Mailing address:
  • Phone: 843-252-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11038
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: