Provider Demographics
NPI:1790839942
Name:ANDERSON, KRISTIN DARIUS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:DARIUS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 OAKESDALE DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7818
Mailing Address - Country:US
Mailing Address - Phone:843-473-8213
Mailing Address - Fax:843-582-0261
Practice Address - Street 1:25 CLARK SUMMIT DR STE 103
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4200
Practice Address - Country:US
Practice Address - Phone:843-473-8213
Practice Address - Fax:843-582-0261
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1163103TC0700X, 103T00000X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool