Provider Demographics
NPI:1710668397
Name:PIERCE, KATHRYN ALICIA
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ALICIA
Last Name:PIERCE
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 1:28 SLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5873
Mailing Address - Country:US
Mailing Address - Phone:864-765-6301
Mailing Address - Fax:
Practice Address - Street 1:28 SLOW CREEK DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5873
Practice Address - Country:US
Practice Address - Phone:864-765-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-23-253619106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician