Provider Demographics
NPI:1811392152
Name:WAKEFIELD, KRISTIN (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 PEACHTREE LN NW STE 104
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0422
Mailing Address - Country:US
Mailing Address - Phone:256-735-8152
Mailing Address - Fax:888-255-4996
Practice Address - Street 1:1528 PEACHTREE LN NW STE 104
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0422
Practice Address - Country:US
Practice Address - Phone:256-686-4441
Practice Address - Fax:256-686-4443
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3694C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical