Healthcare Provider Details

I. General information

NPI: 1811677636
Provider Name (Legal Business Name): KRISTEL BYRD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 TOWN CENTRE BLVD # 508
CLAYTON NC
27520-2181
US

IV. Provider business mailing address

921 TOWN CENTRE BLVD # 508
CLAYTON NC
27520-2181
US

V. Phone/Fax

Practice location:
  • Phone: 984-223-0516
  • Fax:
Mailing address:
  • Phone: 994-223-0516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC016370
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904015578
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: