Provider Demographics
NPI:1053718734
Name:MCKNIGHT, KRYSTAL
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:MCKNIGHT
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 1:115 NORTH HAVIN STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4956
Mailing Address - Country:US
Mailing Address - Phone:803-775-5080
Mailing Address - Fax:803-773-6256
Practice Address - Street 1:115 NORTH HAVIN STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4956
Practice Address - Country:US
Practice Address - Phone:803-775-5080
Practice Address - Fax:803-773-6256
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor