Provider Demographics
NPI:1548779101
Name:BLOW, KRISTIN (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BLOW
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3851 DUNHAGAN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6640
Mailing Address - Country:US
Mailing Address - Phone:252-751-0518
Mailing Address - Fax:252-565-4505
Practice Address - Street 1:3000 BETHESDA PL STE 202
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:252-751-0518
Practice Address - Fax:252-565-4505
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC1038103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health