Provider Demographics
NPI:1467205070
Name:PAINTER, KRISTI KILLOUGH (MA, NCC)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:KILLOUGH
Last Name:PAINTER
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:JOANNA LEIGH
Other - Last Name:KILLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:257 CHURCH ST NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4763
Mailing Address - Country:US
Mailing Address - Phone:980-263-9791
Mailing Address - Fax:980-217-4762
Practice Address - Street 1:257 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4763
Practice Address - Country:US
Practice Address - Phone:980-263-9791
Practice Address - Fax:980-217-4762
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health