Provider Demographics
NPI:1821702184
Name:GUDIPALLI, KRISTEN DANIELLE (MSW, LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:DANIELLE
Last Name:GUDIPALLI
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 BUCHANAN CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-3894
Mailing Address - Country:US
Mailing Address - Phone:757-392-5491
Mailing Address - Fax:
Practice Address - Street 1:810 AKRON DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-3853
Practice Address - Country:US
Practice Address - Phone:336-631-1948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0182671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical