Healthcare Provider Details

I. General information

NPI: 1225476971
Provider Name (Legal Business Name): MRS. ELIZABETH ADAMS KINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 SUNSET BLVD
WEST COLUMBIA SC
29169-3041
US

IV. Provider business mailing address

7 BARBERRY CT
COLUMBIA SC
29212-2838
US

V. Phone/Fax

Practice location:
  • Phone: 803-603-4718
  • Fax:
Mailing address:
  • Phone: 803-603-4718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4880
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: