Healthcare Provider Details

I. General information

NPI: 1891993200
Provider Name (Legal Business Name): MRS. KATHLEEN COMPARONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN SIMONE MS

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 GRAYS HWY
RIDGELAND SC
29936-5440
US

IV. Provider business mailing address

1050 RIBAUT RD
BEAUFORT SC
29902-5400
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-9897
  • Fax:
Mailing address:
  • Phone: 843-423-6362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: