Provider Demographics
NPI:1124560719
Name:DUNN, KRISTINE (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:DUNN
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 1:529 M L KING AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-2002
Mailing Address - Country:US
Mailing Address - Phone:810-238-0483
Mailing Address - Fax:810-239-5518
Practice Address - Street 1:529 M L KING AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-2002
Practice Address - Country:US
Practice Address - Phone:810-238-0483
Practice Address - Fax:810-239-5518
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008499103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)