Provider Demographics
NPI:1396117156
Name:BLEVINS, KRISTIN MARIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MARIE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:8253 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438
Mailing Address - Country:US
Mailing Address - Phone:810-428-7477
Mailing Address - Fax:
Practice Address - Street 1:901 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1552
Practice Address - Country:US
Practice Address - Phone:810-232-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801098752104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker