Provider Demographics
NPI:1356237812
Name:DESANTIS, KRISTI MARIE
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:MARIE
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:DESANTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA
Mailing Address - Street 1:740 COUNTY ROAD 212 LOT 132
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-8409
Mailing Address - Country:US
Mailing Address - Phone:419-609-6111
Mailing Address - Fax:
Practice Address - Street 1:430 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GREEN SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:44836-9734
Practice Address - Country:US
Practice Address - Phone:844-534-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH192761101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)