Provider Demographics
NPI:1710618079
Name:BERARD-WHITFIELD, KRISTINE ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ELIZABETH
Last Name:BERARD-WHITFIELD
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 1:8142 BLUEGILL CIR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9563
Mailing Address - Country:US
Mailing Address - Phone:678-372-3545
Mailing Address - Fax:
Practice Address - Street 1:8142 BLUEGILL CIR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-9563
Practice Address - Country:US
Practice Address - Phone:678-372-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013017101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor