Provider Demographics
NPI:1063676930
Name:CAMP, KRISTINA L (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:L
Last Name:CAMP
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N ALABAMA ST STE 320
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1432
Mailing Address - Country:US
Mailing Address - Phone:317-644-6412
Mailing Address - Fax:317-464-9575
Practice Address - Street 1:615 N ALABAMA ST STE 320
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1432
Practice Address - Country:US
Practice Address - Phone:317-644-6412
Practice Address - Fax:317-464-9575
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100264520Medicaid