Provider Demographics
NPI:1629141858
Name:HERNANDEZ-GUZMAN, KIRSIS (LCSWA)
Entity Type:Individual
Prefix:
First Name:KIRSIS
Middle Name:
Last Name:HERNANDEZ-GUZMAN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 ROCKGLEN WAY
Mailing Address - Street 2:206
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-7561
Mailing Address - Country:US
Mailing Address - Phone:616-706-1424
Mailing Address - Fax:
Practice Address - Street 1:1037 BULLARD CT
Practice Address - Street 2:SUITE 208
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6871
Practice Address - Country:US
Practice Address - Phone:919-877-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0091431041C0700X
NCLCAS-23178101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical