Active NPI
Kristen Ezsol
- Mental Health Counselor
- North Charleston, SC
National Provider Identifier
1841866365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 7657
- Practice address
- 2811 Tricom St
North Charleston, SC 29406-9172 - Phone
- (843) 619-7989
- NPI assigned
- Jun 3, 2021
- Last updated
- Jun 3, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 7657 | SC | Primary |
Addresses
Primary practice location
2811 Tricom St
North Charleston, SC 29406-9172
Mailing address
3885 Hottinger Ave
North Charleston, SC 29405-7019
Phone (716) 725-1451
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7657 | SC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622678400000",
"number": "1841866365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3885 HOTTINGER AVE",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "294057019",
"telephone_number": "716-725-1451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2811 TRICOM ST",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "294069172",
"telephone_number": "843-619-7989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZSOL",
"first_name": "KRISTEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-03",
"last_updated": "2021-06-03",
"certification_date": "2021-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "SC",
"license": "7657",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.