Provider Demographics
NPI:1629514831
Name:PRINCINSKY, KRISTINA M (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:PRINCINSKY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2392
Mailing Address - Country:US
Mailing Address - Phone:810-215-0303
Mailing Address - Fax:248-994-8090
Practice Address - Street 1:762 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2392
Practice Address - Country:US
Practice Address - Phone:810-215-0303
Practice Address - Fax:248-994-8090
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016903103TC0700X
MI6401016366101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical