Provider Demographics
NPI:1780760900
Name:KITCHEN, KRISTIN WILSON (SOCIAL WORKER MSSW)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:WILSON
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:SOCIAL WORKER MSSW
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2579 DOUGLAS AVE
Mailing Address - Street 2:SOUTHEAST MENTAL HEALTH CENTER
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38114
Mailing Address - Country:US
Mailing Address - Phone:901-369-1480
Mailing Address - Fax:901-369-1452
Practice Address - Street 1:3810 WINCHESTER RD
Practice Address - Street 2:SOUTHEAST MENTAL HEALTH CENTER
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-9007
Practice Address - Country:US
Practice Address - Phone:901-369-1420
Practice Address - Fax:901-369-1433
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4703104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker