Provider Demographics
NPI:1508202912
Name:MUMPOWER, KRISTIN (LPA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:MUMPOWER
Suffix:
Gender:F
Credentials:LPA, BCBA
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:WILKINSON
Other - Last Name:YONKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:512 KELLYRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-9531
Mailing Address - Country:US
Mailing Address - Phone:910-228-3091
Mailing Address - Fax:910-516-1682
Practice Address - Street 1:512 KELLYRIDGE DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-9531
Practice Address - Country:US
Practice Address - Phone:910-228-3091
Practice Address - Fax:910-516-1682
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-13055103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst