Provider Demographics
NPI:1346390994
Name:FORD, KRISTIN CAROLINE (REGISTERED RECOVERY)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:CAROLINE
Last Name:FORD
Suffix:
Gender:F
Credentials:REGISTERED RECOVERY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5713
Mailing Address - Country:US
Mailing Address - Phone:805-925-5717
Mailing Address - Fax:
Practice Address - Street 1:6500 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4142
Practice Address - Country:US
Practice Address - Phone:805-461-5212
Practice Address - Fax:805-461-5873
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)