Provider Demographics
NPI:1073782314
Name:SCHMIDT, KRISTINE MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 WESSINGTON MANOR LN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7850
Mailing Address - Country:US
Mailing Address - Phone:704-661-8610
Mailing Address - Fax:855-445-0292
Practice Address - Street 1:1085 WESSINGTON MANOR LN
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7850
Practice Address - Country:US
Practice Address - Phone:704-661-8610
Practice Address - Fax:855-445-0292
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0058071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical