Provider Demographics
NPI:1588704100
Name:TRAUCHT, KRISTINE ANN (LMBT, NCMMT)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ANN
Last Name:TRAUCHT
Suffix:
Gender:F
Credentials:LMBT, NCMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WESTERN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6822
Mailing Address - Country:US
Mailing Address - Phone:910-381-2262
Mailing Address - Fax:910-346-0988
Practice Address - Street 1:411 WESTERN BLVD STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6822
Practice Address - Country:US
Practice Address - Phone:910-381-2262
Practice Address - Fax:910-346-0988
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5806174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist