Provider Demographics
NPI:1669432787
Name:SPRINGER, KURT ELVIN (MSW, LCSW, QP, SAC)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:ELVIN
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:MSW, LCSW, QP, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7039 ROCKRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-8029
Mailing Address - Country:US
Mailing Address - Phone:910-425-8024
Mailing Address - Fax:
Practice Address - Street 1:2944 BREEZEWOOD AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5415
Practice Address - Country:US
Practice Address - Phone:910-609-1717
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005173101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC005173OtherNC SWCLB LCSW NUMBER
NC6106264Medicaid