Provider Demographics
NPI:1578014718
Name:ROWLAND, KRISTY KAYE
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:KAYE
Last Name:ROWLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:MERCER
Other - Last Name:ROWLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAS
Mailing Address - Street 1:3707 MARION COURT N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896
Mailing Address - Country:US
Mailing Address - Phone:252-230-6403
Mailing Address - Fax:
Practice Address - Street 1:3707 MARION COURT N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896
Practice Address - Country:US
Practice Address - Phone:252-230-6403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-2838101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)