Provider Demographics
NPI:1629679030
Name:CARRILLO GEORGE, KRYSTALIA R
Entity Type:Individual
Prefix:MRS
First Name:KRYSTALIA
Middle Name:R
Last Name:CARRILLO GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305333
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00803-5333
Mailing Address - Country:US
Mailing Address - Phone:340-998-3835
Mailing Address - Fax:
Practice Address - Street 1:ESTATE HOPE 2E
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-5333
Practice Address - Country:US
Practice Address - Phone:340-998-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker