Provider Demographics
NPI:1164868840
Name:MCNULTY, KRISTIN R (CATC / RAS)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:R
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:CATC / RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HARRIS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-3249
Mailing Address - Country:US
Mailing Address - Phone:916-649-6793
Mailing Address - Fax:
Practice Address - Street 1:310 HARRIS AVE STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838
Practice Address - Country:US
Practice Address - Phone:916-649-6793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)