Provider Demographics
NPI:1194345470
Name:NEEDHAM, KRISTY DAWN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:DAWN
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:DAWN
Other - Last Name:ALANIS-COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:270 ESTELLE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-5679
Mailing Address - Country:US
Mailing Address - Phone:336-960-5584
Mailing Address - Fax:
Practice Address - Street 1:270 ESTELLE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-5679
Practice Address - Country:US
Practice Address - Phone:910-722-9606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0149991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical