Provider Demographics
NPI:1801037734
Name:PECK, KRISTINA MURPHY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:MURPHY
Last Name:PECK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 FAIRVIEW RD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3167
Mailing Address - Country:US
Mailing Address - Phone:704-365-1844
Mailing Address - Fax:
Practice Address - Street 1:5970 FAIRVIEW RD
Practice Address - Street 2:SUITE 412
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3167
Practice Address - Country:US
Practice Address - Phone:704-365-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3627103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist