Provider Demographics
NPI:1215052436
Name:HAMMOND, KRISTIN ROSE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ROSE
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1186 N MAIN ST
Mailing Address - Street 2:P.O. BOX 1921
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-6640
Mailing Address - Country:US
Mailing Address - Phone:910-814-0909
Mailing Address - Fax:910-814-0915
Practice Address - Street 1:1186 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-6640
Practice Address - Country:US
Practice Address - Phone:910-814-0909
Practice Address - Fax:910-814-0915
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO37641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002861Medicaid
NC2879460Medicare ID - Type Unspecified