Provider Demographics
NPI:1639711690
Name:SUITCA, CRISTINA LYN (MSW, LISW)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:LYN
Last Name:SUITCA
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:MISS
Other - First Name:CRISTINA
Other - Middle Name:LYN
Other - Last Name:HAMPU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:PO BOX 2688
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-0688
Mailing Address - Country:US
Mailing Address - Phone:330-680-9020
Mailing Address - Fax:
Practice Address - Street 1:2011 GLAMORGAN ST STE B
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2709
Practice Address - Country:US
Practice Address - Phone:330-614-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.19018421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical