Provider Demographics
NPI:1417356627
Name:LANFORD, KRISTINA (PIP,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:LANFORD
Suffix:
Gender:F
Credentials:PIP,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BEL AIR BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3514
Mailing Address - Country:US
Mailing Address - Phone:251-418-5050
Mailing Address - Fax:251-478-5015
Practice Address - Street 1:605 BEL AIR BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3514
Practice Address - Country:US
Practice Address - Phone:251-418-5050
Practice Address - Fax:251-478-5015
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1142-3657C101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional