Provider Demographics
NPI:1013523083
Name:STANZIONE, KRISTA (MS, LGPC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:STANZIONE
Suffix:
Gender:F
Credentials:MS, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 DEAN LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7975
Mailing Address - Country:US
Mailing Address - Phone:443-286-8666
Mailing Address - Fax:
Practice Address - Street 1:5301 BUCKEYSTOWN PIKE STE 480F
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8370
Practice Address - Country:US
Practice Address - Phone:240-823-5890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2022-12-14
Deactivation Date:2021-09-23
Deactivation Code:
Reactivation Date:2021-10-07
Provider Licenses
StateLicense IDTaxonomies
MDLGP10616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional