Provider Demographics
NPI:1407900368
Name:KIRSTNER, KATHERINE M (MS-EDS, NCC, LCMHC)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:M
Last Name:KIRSTNER
Suffix:
Gender:F
Credentials:MS-EDS, NCC, LCMHC
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:M
Other - Last Name:KIRSTNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS-EDS, NCC, LCMHC
Mailing Address - Street 1:3707 W MARKET ST STE D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1399
Mailing Address - Country:US
Mailing Address - Phone:336-420-9340
Mailing Address - Fax:336-323-1615
Practice Address - Street 1:3707 W MARKET ST STE D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1399
Practice Address - Country:US
Practice Address - Phone:336-420-9340
Practice Address - Fax:336-323-1615
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102404Medicaid
NC1379EOtherBCBS PRRVIDER #