Provider Demographics
NPI:1831841873
Name:FALLON, KRISTINA WOUNG (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:WOUNG
Last Name:FALLON
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:WOUNG-FALLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC, NCC
Mailing Address - Street 1:7 DELANEY CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-5568
Mailing Address - Country:US
Mailing Address - Phone:908-256-4655
Mailing Address - Fax:
Practice Address - Street 1:1124 US HIGHWAY 202 STE B10
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1463
Practice Address - Country:US
Practice Address - Phone:908-977-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00817000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional