Provider Demographics
NPI:1154055390
Name:KAISER, ANITA SHANEL (MA, LPC)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:SHANEL
Last Name:KAISER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 OVERCUP LOOP
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-6969
Mailing Address - Country:US
Mailing Address - Phone:910-813-6431
Mailing Address - Fax:
Practice Address - Street 1:277 OVERCUP LOOP
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-6969
Practice Address - Country:US
Practice Address - Phone:803-921-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9964101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC435201Medicaid