Provider Demographics
NPI:1770818460
Name:VIRUSO-KITTS, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:VIRUSO-KITTS
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 1:5029 SPICEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-5315
Mailing Address - Country:US
Mailing Address - Phone:803-792-0751
Mailing Address - Fax:
Practice Address - Street 1:5029 SPICEWOOD DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-5315
Practice Address - Country:US
Practice Address - Phone:803-792-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6446101YP2500X
SC6980101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional