Provider Demographics
NPI:1063165116
Name:CHRISTOLIN, USELINE
Entity type:Individual
Prefix:
First Name:USELINE
Middle Name:
Last Name:CHRISTOLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CONCORD PLACE RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7933
Mailing Address - Country:US
Mailing Address - Phone:803-476-7604
Mailing Address - Fax:
Practice Address - Street 1:205 CONCORD PLACE RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7933
Practice Address - Country:US
Practice Address - Phone:803-467-7604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health