Provider Demographics
NPI:1497816029
Name:GROGAN, KATHRYN LINDSEY (LISW-CP-S)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LINDSEY
Last Name:GROGAN
Suffix:
Gender:F
Credentials:LISW-CP-S
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:LINDSEY
Other - Last Name:ROSINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1633 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7755
Mailing Address - Country:US
Mailing Address - Phone:803-520-8295
Mailing Address - Fax:
Practice Address - Street 1:301 PALMETTO PARK BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7872
Practice Address - Country:US
Practice Address - Phone:803-359-7206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC73791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health