Provider Demographics
NPI:1295224061
Name:STROUSE, CHRISTY (RDN)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:STROUSE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MISS
Other - First Name:CHRISTY
Other - Middle Name:MARIE
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6308
Mailing Address - Fax:
Practice Address - Street 1:2104 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-676-1072
Practice Address - Fax:864-676-0729
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC917133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered