Provider Demographics
NPI:1568236982
Name:POPPE, KRISTEN (LCMHCA, LCASA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:POPPE
Suffix:
Gender:F
Credentials:LCMHCA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 COLWICK LN
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6627
Mailing Address - Country:US
Mailing Address - Phone:919-412-9416
Mailing Address - Fax:
Practice Address - Street 1:6112 SAINT GILES ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7043
Practice Address - Country:US
Practice Address - Phone:919-893-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18783101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)