Provider Demographics
NPI:1972854636
Name:LEE, KRISTINA A
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 OLD SEWARD HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3358
Mailing Address - Country:US
Mailing Address - Phone:907-341-5334
Mailing Address - Fax:907-341-5322
Practice Address - Street 1:8130 OLD SEWARD HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3358
Practice Address - Country:US
Practice Address - Phone:907-341-5334
Practice Address - Fax:907-341-5322
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker