Provider Demographics
NPI:1619695301
Name:ANDERSON, KRISTIN PATRICE (MS-PSY)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:PATRICE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS-PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2608
Mailing Address - Country:US
Mailing Address - Phone:681-207-7123
Mailing Address - Fax:
Practice Address - Street 1:135 ABBEY LN
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-9083
Practice Address - Country:US
Practice Address - Phone:304-222-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health