Provider Demographics
NPI:1245379973
Name:NUTT, KRISTINE LYNN (LCSW, LCAS, CCS)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LYNN
Last Name:NUTT
Suffix:
Gender:F
Credentials:LCSW, LCAS, CCS
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:LYNN
Other - Last Name:TAMBINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LCAS
Mailing Address - Street 1:814 S GROVE ST STE A
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-5785
Mailing Address - Country:US
Mailing Address - Phone:828-577-2598
Mailing Address - Fax:
Practice Address - Street 1:814 S GROVE ST STE A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5785
Practice Address - Country:US
Practice Address - Phone:828-577-2598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC711101YA0400X
NCC0043551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002567Medicaid
NC285266Medicare Oscar/Certification