Provider Demographics
NPI:1427358308
Name:DAVIS, KRISTIE NONE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KRISTIE
Middle Name:NONE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:KRISTIE
Other - Middle Name:NONE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:123 DOROTHY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-9198
Mailing Address - Country:US
Mailing Address - Phone:843-793-8324
Mailing Address - Fax:843-871-8579
Practice Address - Street 1:123 DOROTHY DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-9198
Practice Address - Country:US
Practice Address - Phone:843-793-8324
Practice Address - Fax:843-871-8579
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4267101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD16DOMedicaid