Provider Demographics
NPI:1073607602
Name:HEUSTESS, KATHY T (MSW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:T
Last Name:HEUSTESS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NORTH KINGS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577
Mailing Address - Country:US
Mailing Address - Phone:843-448-4820
Mailing Address - Fax:843-448-9875
Practice Address - Street 1:901 NORTH KINGS HIGHWAY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-448-4820
Practice Address - Fax:843-448-9875
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC05101411101YA0400X
VAAAPC FELLOW101YP1600X
SC50041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical