Provider Demographics
NPI:1801434618
Name:MARINO, KIRSTEN KAY (MED, LPCA, NCC)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:KAY
Last Name:MARINO
Suffix:
Gender:F
Credentials:MED, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 CAISTOR LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7215
Mailing Address - Country:US
Mailing Address - Phone:617-216-7235
Mailing Address - Fax:
Practice Address - Street 1:808 SALEM WOODS DR STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3345
Practice Address - Country:US
Practice Address - Phone:617-216-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional