Provider Demographics
NPI:1780928531
Name:MARCH, KRISTINA M (LPCC)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:M
Last Name:MARCH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6596 SAHCHU LN
Mailing Address - Street 2:
Mailing Address - City:COCHITI LAKE
Mailing Address - State:NM
Mailing Address - Zip Code:87083-6013
Mailing Address - Country:US
Mailing Address - Phone:505-366-1842
Mailing Address - Fax:
Practice Address - Street 1:6596 SAHCHU LN
Practice Address - Street 2:
Practice Address - City:COCHITI LAKE
Practice Address - State:NM
Practice Address - Zip Code:87083-6013
Practice Address - Country:US
Practice Address - Phone:505-366-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-18
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0175271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional