1265712137 NPI number — MRS. KRISTINE EMMA RUFENACHT MSW, LISW-CP, LCSW

Table of content: MRS. KRISTINE EMMA RUFENACHT MSW, LISW-CP, LCSW (NPI 1265712137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265712137 NPI number — MRS. KRISTINE EMMA RUFENACHT MSW, LISW-CP, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUFENACHT
Provider First Name:
KRISTINE
Provider Middle Name:
EMMA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LISW-CP, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUFENACHT
Provider Other First Name:
KRISTINE
Provider Other Middle Name:
EMMA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265712137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1528 UNION ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GASTONIA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-272-2800
Provider Business Mailing Address Fax Number:
513-631-7484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 NORTHPARK DRIVE
Provider Second Line Business Practice Location Address:
SUITE 200/201
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-327-3636
Provider Business Practice Location Address Fax Number:
803-327-3638
Provider Enumeration Date:
08/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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