Provider Demographics
NPI:1568498954
Name:GRABENBAUER, KRISTA (LISW)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:GRABENBAUER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-1509
Mailing Address - Country:US
Mailing Address - Phone:843-263-6124
Mailing Address - Fax:843-524-5202
Practice Address - Street 1:2201 BOUNDARY ST
Practice Address - Street 2:SUITE 307
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-3860
Practice Address - Country:US
Practice Address - Phone:843-263-6124
Practice Address - Fax:843-524-5202
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1420104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker