Provider Demographics
NPI:1285855221
Name:WITTENBROOK, KRISTIN LEE (BA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:WITTENBROOK
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-1815
Mailing Address - Country:US
Mailing Address - Phone:740-676-1515
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 256 A
Practice Address - Street 2:
Practice Address - City:TRIADELPHIA
Practice Address - State:WV
Practice Address - Zip Code:26059-9725
Practice Address - Country:US
Practice Address - Phone:304-547-9197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)