Provider Demographics
NPI:1902465099
Name:KOLSUT, KARLI ELAINE
Entity Type:Individual
Prefix:MS
First Name:KARLI
Middle Name:ELAINE
Last Name:KOLSUT
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 1:1400 LAUREL ST STE 4A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2500
Mailing Address - Country:US
Mailing Address - Phone:803-394-5619
Mailing Address - Fax:803-339-1907
Practice Address - Street 1:1400 LAUREL ST STE 4A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2500
Practice Address - Country:US
Practice Address - Phone:803-394-5619
Practice Address - Fax:803-339-1907
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician