Provider Demographics
NPI:1689708828
Name:KOLIN, KRISTIN JULIE (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JULIE
Last Name:KOLIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 MYRTLE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4598
Mailing Address - Country:US
Mailing Address - Phone:704-687-3136
Mailing Address - Fax:
Practice Address - Street 1:1121 MYRTLE AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4598
Practice Address - Country:US
Practice Address - Phone:704-687-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4590101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor