Provider Demographics
NPI:1619734571
Name:WISCHUSEN, KERRY R (MA, LPCA)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:R
Last Name:WISCHUSEN
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SAWYER CIR UNIT 431
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8625
Mailing Address - Country:US
Mailing Address - Phone:908-347-0501
Mailing Address - Fax:
Practice Address - Street 1:710 JOHNNIE DODDS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3045
Practice Address - Country:US
Practice Address - Phone:843-800-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health