Healthcare Provider Details

I. General information

NPI: 1821901711
Provider Name (Legal Business Name): KAITLYN THOMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3681 LEAPHART RD
WEST COLUMBIA SC
29169-3068
US

IV. Provider business mailing address

210 W WASHINGTON ST
WINNSBORO SC
29180-1331
US

V. Phone/Fax

Practice location:
  • Phone: 803-479-3535
  • Fax:
Mailing address:
  • Phone: 803-801-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCOU.11214PCI
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: