Provider Demographics
NPI:1548637754
Name:CHESHIRE, KRISTIN MICHELE (LPCA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELE
Last Name:CHESHIRE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 BLUFORD ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-3121
Mailing Address - Country:US
Mailing Address - Phone:336-285-2605
Mailing Address - Fax:
Practice Address - Street 1:913 BLUFORD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-3121
Practice Address - Country:US
Practice Address - Phone:336-285-2605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11635101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional