Provider Demographics
NPI:1790016251
Name:KRIES, CAROLE ANN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:ANN
Last Name:KRIES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 CONGRESS ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2757
Mailing Address - Country:US
Mailing Address - Phone:619-977-3439
Mailing Address - Fax:619-688-1098
Practice Address - Street 1:2725 CONGRESS ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2757
Practice Address - Country:US
Practice Address - Phone:619-977-3439
Practice Address - Fax:619-688-1098
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32624106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist