Provider Demographics
NPI:1497832760
Name:PING, KRISTINE MARIE (ACSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:PING
Suffix:
Gender:F
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 RENAISSANCE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-1223
Mailing Address - Country:US
Mailing Address - Phone:765-404-6411
Mailing Address - Fax:765-449-1769
Practice Address - Street 1:865 RENAISSANCE ST
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-1223
Practice Address - Country:US
Practice Address - Phone:765-404-6411
Practice Address - Fax:765-449-1769
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8966-C1041C0700X
IN34003627A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical