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NPI Code Detail

MEDICARE: KRISTINA MARIE BASTONE-BAKER LCMHC, NCC

MEDICARE: KRISTINA MARIE BASTONE-BAKER LCMHC, NCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor16693NC

General Provider Information

NPI Number : 1588330583
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA MARIE BASTONE-BAKER LCMHC, NCC
Provider Business Mailing Address
First Line : 180 MINE LAKE CT STE 100
Second Line :
City : RALEIGH
State : NC
Zip : 27615-6417
Country : US
Telephone Number : 919-238-1113
Fax Number :
Provider Business Practice Location Address
First Line : 3801 BARRETT DR
Second Line :
City : RALEIGH
State : NC
Zip : 27609-7224
Country : US
Telephone Number : 919-870-8409
Fax Number : 877-622-8953
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2021
Last Update Date : 01/08/2026

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