Provider Demographics
NPI:1578813812
Name:GUISE, KRISTIN CAROL (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CAROL
Last Name:GUISE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:CAROL
Other - Last Name:SOLCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 W CARLETON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-5034
Mailing Address - Country:US
Mailing Address - Phone:517-212-8140
Mailing Address - Fax:517-212-8141
Practice Address - Street 1:240 W CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-5034
Practice Address - Country:US
Practice Address - Phone:517-212-8140
Practice Address - Fax:517-212-8141
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010939151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical