Provider Demographics
NPI:1083366637
Name:DAUGHERTY, KRISTINA LEANN (LCSW, LCDC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LEANN
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 APPENNINI CV
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4303
Mailing Address - Country:US
Mailing Address - Phone:512-560-7018
Mailing Address - Fax:
Practice Address - Street 1:2906 APPENNINI CV
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4303
Practice Address - Country:US
Practice Address - Phone:512-560-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX321301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical