Provider Demographics
NPI:1689833410
Name:KESTER, KRISTINE PATRICIA (LCPC RDDP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:PATRICIA
Last Name:KESTER
Suffix:
Gender:F
Credentials:LCPC RDDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S MCHENRY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7487
Mailing Address - Country:US
Mailing Address - Phone:224-789-9065
Mailing Address - Fax:
Practice Address - Street 1:800 S MCHENRY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7487
Practice Address - Country:US
Practice Address - Phone:224-789-9065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL26884101YA0400X
IL180005854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)