Provider Demographics
NPI:1255685764
Name:STRAUB, KRISTAL EVON (LSW)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:EVON
Last Name:STRAUB
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-2232
Mailing Address - Country:US
Mailing Address - Phone:304-573-1883
Mailing Address - Fax:
Practice Address - Street 1:180 OLD SCHOOLHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:WV
Practice Address - Zip Code:24935
Practice Address - Country:US
Practice Address - Phone:304-466-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15-312101YA0400X
WVAP00942661104100000X
WV697101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker