Provider Demographics
NPI:1083505432
Name:CULLEN, KRISTEN (LCSWA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CULLEN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 COPAIN CV
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5291
Mailing Address - Country:US
Mailing Address - Phone:831-521-1130
Mailing Address - Fax:
Practice Address - Street 1:5204 COPAIN CV
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-5291
Practice Address - Country:US
Practice Address - Phone:831-521-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP02114081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty