Basic Information
| Provider Information | |||||||||
| NPI: | 1245791748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTLEY | ||||||||
| FirstName: | KRISTEN | ||||||||
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| Credential: | LPCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 GOVERNMENT AVE SW STE 305 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286022954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287546087 | ||||||||
| FaxNumber: | 8287541344 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 QUEEN ST | ||||||||
| Address2: | |||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286553341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284398191 | ||||||||
| FaxNumber: | 8284392588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2019 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A14742 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | A14742 | 05 | NC | MEDICAID |