Provider Demographics
NPI:1043656218
Name:MISLAK, KRISTIN R (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:R
Last Name:MISLAK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1925 GREENSPRING DR
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4128
Mailing Address - Country:US
Mailing Address - Phone:410-453-9553
Mailing Address - Fax:443-612-1488
Practice Address - Street 1:1040 HARDEES DR STE F
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2665
Practice Address - Country:US
Practice Address - Phone:410-273-1399
Practice Address - Fax:410-273-2085
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD144671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical