Provider Demographics
NPI:1679834485
Name:VERNON, KRISTIN BAYSEK (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:BAYSEK
Last Name:VERNON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 S STEELE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4201
Mailing Address - Country:US
Mailing Address - Phone:919-776-0303
Mailing Address - Fax:
Practice Address - Street 1:138 S STEELE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4201
Practice Address - Country:US
Practice Address - Phone:919-776-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0052801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical