Provider Demographics
NPI:1942753165
Name:MCQUILLIAN, KRISTA DANIELLE (LLMSW)
Entity Type:Individual
Prefix:MISS
First Name:KRISTA
Middle Name:DANIELLE
Last Name:MCQUILLIAN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 S BELSAY RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1620
Mailing Address - Country:US
Mailing Address - Phone:734-245-6203
Mailing Address - Fax:
Practice Address - Street 1:1134 S LINDEN RD STE 8
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3455
Practice Address - Country:US
Practice Address - Phone:810-877-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801105172101Y00000X, 101YM0800X, 1041S0200X, 1041C0700X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other