Provider Demographics
NPI:1811736481
Name:KINGAN, KRISTY (MS, NCC)
Entity type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:
Last Name:KINGAN
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3110
Mailing Address - Country:US
Mailing Address - Phone:484-678-4985
Mailing Address - Fax:
Practice Address - Street 1:6314 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3110
Practice Address - Country:US
Practice Address - Phone:484-678-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health