Provider Demographics
NPI:1780472837
Name:CHAMPAGNE, KRISTIN LEE (NBC-HWC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:CHAMPAGNE
Suffix:
Gender:
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C T CORPORATION SYSTEM
Mailing Address - Street 2:67 BURNSIDE AVE
Mailing Address - City:EAST HARFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3408
Mailing Address - Country:US
Mailing Address - Phone:800-516-0975
Mailing Address - Fax:
Practice Address - Street 1:58 VENICE DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06013-2509
Practice Address - Country:US
Practice Address - Phone:860-985-9845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTA-4080566171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty