Provider Demographics
NPI:1497577506
Name:KIEWEL, KIRSTEN MAY (BA)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MAY
Last Name:KIEWEL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 JAECKLE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2843
Mailing Address - Country:US
Mailing Address - Phone:910-660-8200
Mailing Address - Fax:
Practice Address - Street 1:3360 JAECKLE DR STE 120
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2843
Practice Address - Country:US
Practice Address - Phone:910-660-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician