Provider Demographics
NPI:1245494764
Name:KISSLINGER, STEPHEN A (PSYD, MDIV)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:KISSLINGER
Suffix:
Gender:
Credentials:PSYD, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STEPHEN KISSLINGER
Mailing Address - Street 2:105 STAFFORD DR
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745
Mailing Address - Country:US
Mailing Address - Phone:803-246-0844
Mailing Address - Fax:
Practice Address - Street 1:DR STEPHEN A. KISSLINGER
Practice Address - Street 2:2670 MILLS PARK DR
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-366-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1209103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1245494764Medicaid
ND14858Medicaid
ND14858Medicaid