Provider Demographics
NPI:1902400997
Name:COLLINS, KRISTIN CIARA (MA, LCMHCA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CIARA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 KRUEST DR
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:15042-2736
Mailing Address - Country:US
Mailing Address - Phone:724-777-9102
Mailing Address - Fax:
Practice Address - Street 1:180 KRUEST DR
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:15042-2736
Practice Address - Country:US
Practice Address - Phone:724-777-9102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16078101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health