Provider Demographics
NPI:1659543585
Name:RUDY, KRISTEN DANIELLE (MS, ATR, NCC, LPC)
Entity Type:Individual
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First Name:KRISTEN
Middle Name:DANIELLE
Last Name:RUDY
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Gender:F
Credentials:MS, ATR, NCC, LPC
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Mailing Address - Street 1:3205 RANDALL PKWY
Mailing Address - Street 2:STE. 128
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3205 RANDALL PKWY
Practice Address - Street 2:STE. 128
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2564
Practice Address - Country:US
Practice Address - Phone:910-777-1866
Practice Address - Fax:910-777-5680
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health