Provider Demographics
NPI:1184336430
Name:CLAMP, KRISTINA A (RADT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:A
Last Name:CLAMP
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PEACH DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3710
Mailing Address - Country:US
Mailing Address - Phone:831-753-6001
Mailing Address - Fax:
Practice Address - Street 1:11 PEACH DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3710
Practice Address - Country:US
Practice Address - Phone:831-753-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD4899329101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)