Provider Demographics
NPI:1346775707
Name:ALBERT, KRISTEN (BCABA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ALBERT
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 BURDETTE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1003
Mailing Address - Country:US
Mailing Address - Phone:864-612-0149
Mailing Address - Fax:
Practice Address - Street 1:195 BURDETTE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1003
Practice Address - Country:US
Practice Address - Phone:864-612-0149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-17-7621106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst