Healthcare Provider Details

I. General information

NPI: 1770401960
Provider Name (Legal Business Name): KRISTYN CALICCHIO OWENS LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206A WRIGHTSVILLE AVE
WILMINGTON NC
28403-2406
US

IV. Provider business mailing address

123 LIGHTWOOD KNOT RD
ROCKY POINT NC
28457-9212
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-6499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023842
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: