Provider Demographics
NPI:1336465269
Name:ACOSTA, KRISTINA MATHEWS (PHD, NCC, LPC, LCAS)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:MATHEWS
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PHD, NCC, LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10002 FARM POND RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5787
Mailing Address - Country:US
Mailing Address - Phone:704-806-7535
Mailing Address - Fax:
Practice Address - Street 1:10002 FARM POND RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5787
Practice Address - Country:US
Practice Address - Phone:704-806-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7687101Y00000X, 101YM0800X, 101YP2500X, 103TC1900X
NC1527101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling