Provider Demographics
NPI:1174696470
Name:BAGLEY, KRISTEN (LISW-CP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SALTERBECK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7165
Mailing Address - Country:US
Mailing Address - Phone:843-670-9423
Mailing Address - Fax:
Practice Address - Street 1:3301 SALTERBECK ST STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7165
Practice Address - Country:US
Practice Address - Phone:516-822-4060
Practice Address - Fax:516-396-0559
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0760261041C0700X
SC160341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical