MEDICARE: KRISTIN ELIZABETH

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	106H00000X	Marriage & Family Therapist	10906	SC

General Provider Information

NPI Number	:	1710822663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ELIZABETH

Provider Business Mailing Address
First Line	:	7124 TOPSAIL CIR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8513
Country	:	US
Telephone Number	:	803-323-9558
Fax Number	:

Provider Business Practice Location Address
First Line	:	1036 ASSEMBLY DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6400
Country	:	US
Telephone Number	:	980-292-2743
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “ KRISTIN ELIZABETH ” Practice Location

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