Provider Demographics
NPI:1326701848
Name:KARRAKER, KRISTIN SHAY (MA, CADC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SHAY
Last Name:KARRAKER
Suffix:
Gender:F
Credentials:MA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 GEORGE BISHOP HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MYRLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577
Mailing Address - Country:US
Mailing Address - Phone:843-492-2820
Mailing Address - Fax:
Practice Address - Street 1:104 GEORGE BISHOP HIGHWAY
Practice Address - Street 2:
Practice Address - City:MYRLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-492-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL35542101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)