Basic Information
| Provider Information | |||||||||
| NPI: | 1528739158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OWENS | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | AUGUST | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1511 WILLOW BAY DR BAY | ||||||||
| Address2: | |||||||||
| City: | EVANS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308097484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065642304 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1135 GREGG HWY NW | ||||||||
| Address2: | |||||||||
| City: | AIKEN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298016341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036417700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2021 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | MSW010207 | GA | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | SW.14477LMSW | SC | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.