Provider Demographics
NPI:1508195793
Name:KYRIAKIDES, MARIO DAVID (MA)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:DAVID
Last Name:KYRIAKIDES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 CHARLES BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5924
Mailing Address - Country:US
Mailing Address - Phone:252-215-5700
Mailing Address - Fax:252-215-5701
Practice Address - Street 1:2428 CHARLES BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5924
Practice Address - Country:US
Practice Address - Phone:252-215-5700
Practice Address - Fax:252-215-5701
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health