Provider Demographics
NPI:1801957691
Name:SLUDER, KRISTIE LEANNE (LCAS)
Entity type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:LEANNE
Last Name:SLUDER
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:MRS
Other - First Name:KRISTIE
Other - Middle Name:
Other - Last Name:SLUDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAS
Mailing Address - Street 1:60 BLACKBERRY INN RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9754
Mailing Address - Country:US
Mailing Address - Phone:828-649-9999
Mailing Address - Fax:828-575-5316
Practice Address - Street 1:60 BLACKBERRY INN RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9754
Practice Address - Country:US
Practice Address - Phone:828-333-3609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2148101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106688Medicaid
NC6106688Medicaid