Provider Demographics
NPI:1740543131
Name:FORNERIS, KRISTEN SUZANNE (MS, NCC, LPCA)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:SUZANNE
Last Name:FORNERIS
Suffix:
Gender:F
Credentials:MS, NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 C EAST WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC - NORTH CAROLINA
Mailing Address - Zip Code:27401
Mailing Address - Country:UM
Mailing Address - Phone:336-899-8800
Mailing Address - Fax:
Practice Address - Street 1:234C E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2704
Practice Address - Country:US
Practice Address - Phone:336-899-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health