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NPI Code Detail

MEDICARE: KRISTAN A ROSS MS, LCAS-A

MEDICARE: KRISTAN A ROSS MS, LCAS-A
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLCAS-29980NC

General Provider Information

NPI Number : 1306302799
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTAN A ROSS MS, LCAS-A
Provider Business Mailing Address
First Line : 504 JC DELLINGER RD
Second Line :
City : CHERRYVILLE
State : NC
Zip : 28021-8916
Country : US
Telephone Number : 980-269-3106
Fax Number :
Provider Business Practice Location Address
First Line : 1895 E DIXON BLVD
Second Line :
City : SHELBY
State : NC
Zip : 28152-6901
Country : US
Telephone Number : 980-306-4201
Fax Number : 704-445-7016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2019
Last Update Date : 07/24/2025

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