Provider Demographics
NPI:1366009011
Name:ALONZO-BRILLANT, KERSTIN
Entity Type:Individual
Prefix:
First Name:KERSTIN
Middle Name:
Last Name:ALONZO-BRILLANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 ARSENAL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5478
Mailing Address - Country:US
Mailing Address - Phone:910-323-3368
Mailing Address - Fax:
Practice Address - Street 1:901 ARSENAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5478
Practice Address - Country:US
Practice Address - Phone:910-323-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0134571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical