Provider Demographics
NPI:1962699041
Name:ABRAHAM, KIRSTIN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIRSTIN
Middle Name:
Last Name:ABRAHAM
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 1:8211 AVANTI DR
Mailing Address - Street 2:
Mailing Address - City:MARVIN
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7351
Mailing Address - Country:US
Mailing Address - Phone:704-233-7594
Mailing Address - Fax:
Practice Address - Street 1:8211 AVANTI DR
Practice Address - Street 2:
Practice Address - City:MARVIN
Practice Address - State:NC
Practice Address - Zip Code:28173-7351
Practice Address - Country:US
Practice Address - Phone:704-233-7594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0792751041C0700X
FLSW107541041C0700X
390200000X
NCC0080991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGJ428ZMedicare PIN