Provider Demographics
NPI:1366512188
Name:BIRD, KRISTEN (MS)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:BIRD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4850
Mailing Address - Country:US
Mailing Address - Phone:984-242-0291
Mailing Address - Fax:
Practice Address - Street 1:826 TIMBER DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4850
Practice Address - Country:US
Practice Address - Phone:984-242-0291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52098106H00000X
NC1281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist