MEDICARE: MCAULEY KRISTINA BLACKWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1609671213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCAULEY KRISTINA BLACKWELL

Provider Business Mailing Address
First Line	:	PO BOX 5158
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29304-5158
Country	:	US
Telephone Number	:	864-504-3628
Fax Number	:	864-594-0040

Provider Business Practice Location Address
First Line	:	220 IRBY ST
Second Line	:
City	:	WOODRUFF
State	:	SC
Zip	:	29388-1618
Country	:	US
Telephone Number	:	864-504-3628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	01/08/2026

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