Provider Demographics
NPI:1013763093
Name:LUKE, KRISTINE GABRIELLE HENRY (MPH, LPC-A)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:GABRIELLE HENRY
Last Name:LUKE
Suffix:
Gender:
Credentials:MPH, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5642 MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-3405
Mailing Address - Country:US
Mailing Address - Phone:803-467-4788
Mailing Address - Fax:
Practice Address - Street 1:1 CARRIAGE LN BLDG B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6060
Practice Address - Country:US
Practice Address - Phone:843-608-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10762101YP2500X
SC8075103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10762OtherLICENSE NUMBER