Provider Demographics
NPI:1851941314
Name:SEAGRASS PSYCHOEDUCATIONAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:SEAGRASS PSYCHOEDUCATIONAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:843-540-4533
Mailing Address - Street 1:10 PINCKNEY COLONY RD STE 312
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-4148
Mailing Address - Country:US
Mailing Address - Phone:843-473-8213
Mailing Address - Fax:
Practice Address - Street 1:10 PINCKNEY COLONY RD STE 312
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-4148
Practice Address - Country:US
Practice Address - Phone:843-473-8213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty