Provider Demographics
NPI:1952654501
Name:JAEGER, KRISTIN D (LCAS)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:JAEGER
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-4007
Mailing Address - Country:US
Mailing Address - Phone:828-697-2660
Mailing Address - Fax:828-697-2986
Practice Address - Street 1:120 S GROVE ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-4007
Practice Address - Country:US
Practice Address - Phone:828-697-2660
Practice Address - Fax:828-697-2986
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2391101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)