Provider Demographics
NPI:1477049872
Name:GALLOWAY, KRISTI A
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:A
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SAINT ANDREWS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7196
Mailing Address - Country:US
Mailing Address - Phone:843-310-4165
Mailing Address - Fax:
Practice Address - Street 1:711 SAINT ANDREWS BLVD STE A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7196
Practice Address - Country:US
Practice Address - Phone:843-310-4165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid