Basic Information
| Provider Information | |||||||||
| NPI: | 1427066612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYESON DZAHRISTOS | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 332 EAST STREET | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486859399 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8623 N WAYNE RD | ||||||||
| Address2: | STE 123 HEGIRA PROGRAMS INC | ||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343670469 | ||||||||
| FaxNumber: | 7343670791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 104100000X | 6801082080 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.