Basic Information
| Provider Information | |||||||||
| NPI: | 1003238585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACTON | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | L.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1051 E STREET | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402880448 | ||||||||
| FaxNumber: | 4402880997 | ||||||||
| Practice Location | |||||||||
| Address1: | 1051 E STREET | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440522134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402880448 | ||||||||
| FaxNumber: | 4402880997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2014 | ||||||||
| LastUpdateDate: | 01/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | S.1201168 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.