Provider Demographics
NPI:1720631997
Name:DEWAN, KRISTIN (LPCA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:DEWAN
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 1:2318 LINDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4732
Mailing Address - Country:US
Mailing Address - Phone:919-749-1093
Mailing Address - Fax:
Practice Address - Street 1:288 EAST ST STE 1001-F7
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-9711
Practice Address - Country:US
Practice Address - Phone:919-704-8449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health