Provider Demographics
NPI:1104024215
Name:WILEY, KRISTINA L (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:WILEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5181 RUSSET DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25313-2121
Mailing Address - Country:US
Mailing Address - Phone:304-539-2789
Mailing Address - Fax:
Practice Address - Street 1:5480 BIG TYLER RD
Practice Address - Street 2:SUMMIT COUNSELING
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1116
Practice Address - Country:US
Practice Address - Phone:304-539-2789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1844101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1844OtherLPC