Provider Demographics
NPI:1710339759
Name:LINDSTROM, CASSIE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CASSIE
Middle Name:MARIE
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:1695 KERNERSVILLE MEDICAL PKWY
Mailing Address - Street 2:KERNERSVILLE VA HCC - MH & BS CLINIC
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7159
Mailing Address - Country:US
Mailing Address - Phone:336-515-5000
Mailing Address - Fax:336-515-5306
Practice Address - Street 1:1695 KERNERSVILLE MEDICAL PKWY
Practice Address - Street 2:VETERANS AFFAIRS
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7159
Practice Address - Country:US
Practice Address - Phone:336-515-5000
Practice Address - Fax:336-515-5306
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-09-16
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Provider Licenses
StateLicense IDTaxonomies
NC5031103TP2701X, 103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy