Provider Demographics
NPI:1831473982
Name:FAINE, KRISTEN L (LICDC,)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:L
Last Name:FAINE
Suffix:
Gender:F
Credentials:LICDC,
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:BRACE-FAINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:31231 STATE ROUTE 37
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43344-8708
Mailing Address - Country:US
Mailing Address - Phone:937-578-3435
Mailing Address - Fax:
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3702
Practice Address - Country:US
Practice Address - Phone:740-387-7977
Practice Address - Fax:740-387-7977
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH944101101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)