Provider Demographics
NPI:1831235647
Name:DALTON, KRISTIE R (EDS)
Entity type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:R
Last Name:DALTON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 SHORT. STREET.
Mailing Address - Street 2:SUITE D.
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501
Mailing Address - Country:US
Mailing Address - Phone:931-397-0333
Mailing Address - Fax:
Practice Address - Street 1:377 SHORT ST.
Practice Address - Street 2:SUITE D
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501
Practice Address - Country:US
Practice Address - Phone:931-528-9399
Practice Address - Fax:931-526-9300
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor