Provider Demographics
NPI:1750938254
Name:CUNDIFF, KRISTINA (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:CUNDIFF
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 EASTGATE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1588
Mailing Address - Country:US
Mailing Address - Phone:509-529-3081
Mailing Address - Fax:509-529-3147
Practice Address - Street 1:1313 N YOUNG ST STE E
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7662
Practice Address - Country:US
Practice Address - Phone:509-301-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60702955101YM0800X
WALW610059101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health