Provider Demographics
NPI:1003516824
Name:KRULL, DINA MARIE (APCC)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:MARIE
Last Name:KRULL
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1544
Mailing Address - Country:US
Mailing Address - Phone:805-712-8088
Mailing Address - Fax:
Practice Address - Street 1:676 PISMO ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3945
Practice Address - Country:US
Practice Address - Phone:805-543-7969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health