Provider Demographics
NPI:1154086007
Name:BORGSTROM, KRYSTINE ELIZABETH (LCSW-A)
Entity Type:Individual
Prefix:
First Name:KRYSTINE
Middle Name:ELIZABETH
Last Name:BORGSTROM
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:KRYSTINE
Other - Middle Name:ELIZABETH
Other - Last Name:CRAVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:289 OLMSTED BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:289 OLMSTED BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8730
Practice Address - Country:US
Practice Address - Phone:910-295-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO168181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical