Provider Demographics
NPI:1326761917
Name:IRWIN, KRISTINA NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:NICOLE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23432 ALBERT DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-6176
Mailing Address - Country:US
Mailing Address - Phone:760-828-8467
Mailing Address - Fax:
Practice Address - Street 1:23432 ALBERT DR UNIT A
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-6176
Practice Address - Country:US
Practice Address - Phone:760-828-8467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX672721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical