Provider Demographics
NPI:1164156626
Name:BAEZ, KRISTEN HADLEY (LCMHC-A, MT-BC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:HADLEY
Last Name:BAEZ
Suffix:
Gender:F
Credentials:LCMHC-A, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 OPEN SIGHT CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8996
Mailing Address - Country:US
Mailing Address - Phone:585-245-1241
Mailing Address - Fax:
Practice Address - Street 1:1748 HERITAGE CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9855
Practice Address - Country:US
Practice Address - Phone:919-529-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17314101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health