Provider Demographics
NPI:1952840431
Name:HANING, KRISTINA (LCSW, LCDC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:HANING
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N SMITH ST
Mailing Address - Street 2:
Mailing Address - City:MALAKOFF
Mailing Address - State:TX
Mailing Address - Zip Code:75148-9475
Mailing Address - Country:US
Mailing Address - Phone:903-887-0697
Mailing Address - Fax:903-887-0698
Practice Address - Street 1:122 SOUTH OLD GUNBARREL LANE
Practice Address - Street 2:#6
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156
Practice Address - Country:US
Practice Address - Phone:903-887-0697
Practice Address - Fax:903-887-0698
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11659101YA0400X
TX532191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)