MEDICARE: DR. KRISTIN DARIUS ANDERSON PSY.D.

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	103TC0700X	Clinical Psychologist	1163	SC
2	103TS0200X	School Psychologist
3	103T00000X	Psychologist	1163	SC

General Provider Information

NPI Number	:	1790839942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN DARIUS ANDERSON PSY.D.

Provider Business Mailing Address
First Line	:	152 OAKESDALE DR
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29909-7818
Country	:	US
Telephone Number	:	843-473-8213
Fax Number	:	843-582-0261

Provider Business Practice Location Address
First Line	:	25 CLARK SUMMIT DR STE 103
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-4200
Country	:	US
Telephone Number	:	843-473-8213
Fax Number	:	843-582-0261

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	12/07/2023

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