Provider Demographics
NPI:1902019763
Name:DAVIS, KRISTINA STARR (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:KRISTINA
Middle Name:STARR
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N WOODS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3149
Mailing Address - Country:US
Mailing Address - Phone:920-738-7795
Mailing Address - Fax:920-882-5448
Practice Address - Street 1:300 N WOODS EDGE DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3149
Practice Address - Country:US
Practice Address - Phone:920-738-7795
Practice Address - Fax:920-882-5448
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2709-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical