Provider Demographics
NPI:1205390994
Name:NAKHLA, KRISTIN (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:NAKHLA
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SUNSET GROVE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-6805
Mailing Address - Country:US
Mailing Address - Phone:919-753-5717
Mailing Address - Fax:
Practice Address - Street 1:300 W EARP ST
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-8763
Practice Address - Country:US
Practice Address - Phone:919-753-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDP0121931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical