Provider Demographics
NPI:1558660175
Name:DALEY, KRISTIN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:DALEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 MOCKINGBIRD LN STE 580
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1171
Mailing Address - Country:US
Mailing Address - Phone:704-910-8381
Mailing Address - Fax:704-981-8282
Practice Address - Street 1:1515 MOCKINGBIRD LN STE 580
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209
Practice Address - Country:US
Practice Address - Phone:704-910-8381
Practice Address - Fax:704-981-8282
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173F00000X
NC4239103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No173F00000XOther Service ProvidersSleep Specialist, PhD
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC164XAOtherBCBSNC
NCQ39341AMedicare PIN