Provider Demographics
NPI:1487018453
Name:FAULKNER, KRISTINA (MS, NCC, LPCA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:MS, NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 WIRKS WORTH CIR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3650
Mailing Address - Country:US
Mailing Address - Phone:513-340-0099
Mailing Address - Fax:
Practice Address - Street 1:123 WIRKS WORTH CIR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3650
Practice Address - Country:US
Practice Address - Phone:513-340-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12165101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional