Provider Demographics
NPI:1669801445
Name:JUSTICE, KIRSTEN BERNADETTE (LPCA)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:BERNADETTE
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 W JOHNSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1245
Mailing Address - Country:US
Mailing Address - Phone:919-606-9674
Mailing Address - Fax:
Practice Address - Street 1:743 W JOHNSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1245
Practice Address - Country:US
Practice Address - Phone:919-606-9674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional