| Kristen D Rudy Sole Mbr | |
|
4014 Oleander Dr Ste 3a Bldg D Wilmington NC 28403-6849 | |
| (910) 777-1866 | |
| (910) 777-5680 |
| Full Name | Kristen D Rudy Sole Mbr |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 4014 Oleander Dr, Wilmington, North Carolina |
| Authorized Official Name and Position | Kristen D Rudy (OWNER) |
| Authorized Official Contact | 9107771866 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kristen D Rudy Sole Mbr 4014 Oleander Dr Ste 3a Bldg D Wilmington NC 28403-6849 Ph: (910) 777-1866 | Kristen D Rudy Sole Mbr 4014 Oleander Dr Ste 3a Bldg D Wilmington NC 28403-6849 Ph: (910) 777-1866 |
| NPI Number | 1073869491 |
|---|---|
| Provider Enumeration Date | 08/03/2012 |
| Last Update Date | 08/03/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073869491 | NPI | - | NPPES |
| 154X1 | Other | NC | BCBSNC |
| 6104288 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 7530 (North Carolina) | Primary |
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