Provider Demographics
NPI:1033778725
Name:HUNT, KRISTAL PATRICE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:PATRICE
Last Name:HUNT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16159 LEXINGTON
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-2432
Mailing Address - Country:US
Mailing Address - Phone:313-231-0108
Mailing Address - Fax:
Practice Address - Street 1:29501 GREENFIELD RD STE 124
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2250
Practice Address - Country:US
Practice Address - Phone:313-283-7659
Practice Address - Fax:313-217-4162
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011041411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical