Provider Demographics
NPI:1568711695
Name:DELLINGER, KRISTY MARIE
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:MARIE
Last Name:DELLINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:MARIE
Other - Last Name:DELLINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3440 AIRWAY DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2065
Mailing Address - Country:US
Mailing Address - Phone:707-544-3299
Mailing Address - Fax:707-544-6837
Practice Address - Street 1:3440 AIRWAY DR
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2065
Practice Address - Country:US
Practice Address - Phone:707-544-3299
Practice Address - Fax:707-544-6837
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor