Provider Demographics
NPI:1235357146
Name:DAVIES, KRISTINA COBB (LPCC-S)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:COBB
Last Name:DAVIES
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:MISS
Other - First Name:KRISTINA
Other - Middle Name:JOYCE
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED/ BS, MHA
Mailing Address - Street 1:230 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 KNOX ST
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1428
Practice Address - Country:US
Practice Address - Phone:606-219-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY102103251S00000X
KY1279101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100292050Medicaid