Provider Demographics
NPI:1457323602
Name:LANCASTER, KIRSTEN K (PSYD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:K
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 ROBESON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5549
Mailing Address - Country:US
Mailing Address - Phone:910-609-1990
Mailing Address - Fax:910-609-1993
Practice Address - Street 1:2411 ROBESON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5549
Practice Address - Country:US
Practice Address - Phone:910-609-1990
Practice Address - Fax:910-609-1993
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2680103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015J8OtherBCBSNC -- GROUP
NC246741OtherCOMPSYCH
NC6000531Medicaid
NC046JGOtherBCBSNC -- INDIVIDUAL
NC015J8OtherBCBSNC -- GROUP