Provider Demographics
NPI:1174042329
Name:GUEST, KIRSTEN LOUISE (MA)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LOUISE
Last Name:GUEST
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HIGH HAMMOCK VILLAS
Mailing Address - Street 2:
Mailing Address - City:SEABROOK ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455
Mailing Address - Country:US
Mailing Address - Phone:864-509-8187
Mailing Address - Fax:
Practice Address - Street 1:9 TOY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3122
Practice Address - Country:US
Practice Address - Phone:864-301-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY011669-01101YM0800X
CALPCC13810101YM0800X
SC7296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health