Provider Demographics
NPI:1205450731
Name:GARAY, KIRSTEN (LCSW)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:GARAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:LARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:615 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6431
Mailing Address - Country:US
Mailing Address - Phone:910-343-0145
Mailing Address - Fax:910-202-9966
Practice Address - Street 1:309 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-3280
Practice Address - Country:US
Practice Address - Phone:910-259-0668
Practice Address - Fax:910-202-9966
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0161451041C0700X
NCC0172171041C0700X
OHS.1802496104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker