Provider Demographics
NPI:1467950642
Name:JONES, KRISTEN PEELE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:PEELE
Last Name:JONES
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 1:4601 LAKE BOONE TRL STE 1B
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7503
Mailing Address - Country:US
Mailing Address - Phone:919-781-1800
Mailing Address - Fax:919-781-1899
Practice Address - Street 1:4601 LAKE BOONE TRL STE 1B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7503
Practice Address - Country:US
Practice Address - Phone:919-781-1800
Practice Address - Fax:919-781-1899
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0122801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical