Provider Demographics
NPI:1851754832
Name:FOREMAN, KRISTINA M (LISW)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:M
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11660 UPPER GILCHRIST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9084
Mailing Address - Country:US
Mailing Address - Phone:740-399-8008
Mailing Address - Fax:
Practice Address - Street 1:11660 UPPER GILCHRIST RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9084
Practice Address - Country:US
Practice Address - Phone:740-399-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHICDC.111000101YA0400X
OHI.16001221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)