Provider Demographics
NPI:1700029725
Name:BRANDON, KRISTIN SNYDER (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SNYDER
Last Name:BRANDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 KAKI CT
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576-5752
Mailing Address - Country:US
Mailing Address - Phone:574-304-2516
Mailing Address - Fax:
Practice Address - Street 1:920 PAVERSTONE DR STE D
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4723
Practice Address - Country:US
Practice Address - Phone:919-896-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33004939A1041C0700X
NCC0108311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty