Basic Information
| Provider Information | |||||||||
| NPI: | 1073761052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | PC | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1280 ALBION ST APT 28 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802202380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107355293 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4851 INDEPENDENCE ST | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800336715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034325040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 03/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 933 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.