Provider Demographics
NPI:1720707755
Name:BERCHULC, KRISTY LYNN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LYNN
Last Name:BERCHULC
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:LYNN
Other - Last Name:STENZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:3050 BLUEBIRD LN APT 200
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9924
Mailing Address - Country:US
Mailing Address - Phone:586-557-6953
Mailing Address - Fax:
Practice Address - Street 1:3050 BLUEBIRD LN APT 200
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9924
Practice Address - Country:US
Practice Address - Phone:586-557-6953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010873641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical