Provider Demographics
NPI:1144547894
Name:MOONEY, KRISTA HORTON (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:HORTON
Last Name:MOONEY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4003
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0041
Mailing Address - Country:US
Mailing Address - Phone:980-230-0587
Mailing Address - Fax:980-230-0587
Practice Address - Street 1:107 N SUMMEY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-1824
Practice Address - Country:US
Practice Address - Phone:704-865-3525
Practice Address - Fax:704-865-3525
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional