Provider Demographics
NPI:1033804398
Name:CREGO, CRISTINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:
Last Name:CREGO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551
Mailing Address - Country:US
Mailing Address - Phone:859-866-9050
Mailing Address - Fax:
Practice Address - Street 1:401 SUNCHASE BLVD APT E
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2895
Practice Address - Country:US
Practice Address - Phone:859-866-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical