Provider Demographics
NPI:1982755633
Name:MOULTON, KRISTA ANN (LICSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANN
Last Name:MOULTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 GROVE VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-4503
Mailing Address - Country:US
Mailing Address - Phone:256-541-3877
Mailing Address - Fax:
Practice Address - Street 1:207 EUSTIS AVE SE STE B
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4275
Practice Address - Country:US
Practice Address - Phone:256-541-3877
Practice Address - Fax:256-541-3877
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1982C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51537000OtherBCBS OF ALABAMA