Provider Demographics
NPI:1144391640
Name:HALKA, KRISTIE HOLDREN
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:HOLDREN
Last Name:HALKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BRAVO LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2815
Mailing Address - Country:US
Mailing Address - Phone:949-360-6132
Mailing Address - Fax:
Practice Address - Street 1:31882 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3222
Practice Address - Country:US
Practice Address - Phone:949-487-6080
Practice Address - Fax:949-487-6090
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker