Provider Demographics
NPI:1184917247
Name:KYC, CHRISTINA ANA STABILE (DSW, LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANA STABILE
Last Name:KYC
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ANA
Other - Last Name:STABILE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:86 MDG, UNIT 3215
Mailing Address - Street 2:RAMSTEIN AB
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09094
Mailing Address - Country:US
Mailing Address - Phone:314-479-2609
Mailing Address - Fax:
Practice Address - Street 1:UNIT 3215 BOX MDG
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09094-3215
Practice Address - Country:US
Practice Address - Phone:314-479-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT948101YA0400X
CT78891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)