Provider Demographics
NPI:1023399573
Name:WALSH, KIERA (BS, CLC, CLD)
Entity Type:Individual
Prefix:
First Name:KIERA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:BS, CLC, CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 BEECH HILL RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-7870
Mailing Address - Country:US
Mailing Address - Phone:843-640-5379
Mailing Address - Fax:
Practice Address - Street 1:1609 BEECH HILL RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7870
Practice Address - Country:US
Practice Address - Phone:843-640-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No374J00000XNursing Service Related ProvidersDoula