Provider Demographics
NPI:1366782161
Name:KILGO, JOHN SIMPSON III (LPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SIMPSON
Last Name:KILGO
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CREEKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3010
Mailing Address - Country:US
Mailing Address - Phone:864-881-2329
Mailing Address - Fax:
Practice Address - Street 1:3443 PELHAM RD STE 300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4178
Practice Address - Country:US
Practice Address - Phone:864-881-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid
SC3333Medicare PIN