Provider Demographics
NPI:1083478762
Name:JUNG, KIRSTEN DENISE
Entity Type:Individual
Prefix:MISS
First Name:KIRSTEN
Middle Name:DENISE
Last Name:JUNG
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 1:6203 MOUNTAIN VINE AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-9063
Mailing Address - Country:US
Mailing Address - Phone:704-797-1543
Mailing Address - Fax:
Practice Address - Street 1:5101 DUNLEA CT STE 201C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-4436
Practice Address - Country:US
Practice Address - Phone:910-899-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician