Provider Demographics
NPI:1174065288
Name:GREGOR-LAVISKA, KRISTINE (MA)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:GREGOR-LAVISKA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 WINDY RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-2410
Mailing Address - Country:US
Mailing Address - Phone:919-303-0273
Mailing Address - Fax:919-303-5986
Practice Address - Street 1:950 WINDY RD
Practice Address - Street 2:SUITE 305
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2410
Practice Address - Country:US
Practice Address - Phone:919-303-0273
Practice Address - Fax:919-303-5986
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional