Provider Demographics
NPI:1568280261
Name:DOSTER, KYLIE CHRISTINE
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:CHRISTINE
Last Name:DOSTER
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 1:3120 QUEENSGATE WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9061
Mailing Address - Country:US
Mailing Address - Phone:770-843-8580
Mailing Address - Fax:
Practice Address - Street 1:570 LONG POINT RD STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7935
Practice Address - Country:US
Practice Address - Phone:843-300-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-24-75218103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst