Provider Demographics
NPI:1417607284
Name:HAFFEY, KERSTIN KEENE BLOMQUIST (PHD)
Entity type:Individual
Prefix:DR
First Name:KERSTIN
Middle Name:KEENE BLOMQUIST
Last Name:HAFFEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KESTIN
Other - Middle Name:K
Other - Last Name:BLOMQUIST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:305A OLD BUNCOMBE RD
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-1817
Mailing Address - Country:US
Mailing Address - Phone:615-403-5624
Mailing Address - Fax:
Practice Address - Street 1:305A OLD BUNCOMBE RD
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1817
Practice Address - Country:US
Practice Address - Phone:864-305-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1709103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical