Individual
MRS. KRISTY LYNN STATEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
506 W MARION AVE STE A, CRYSTAL SPRINGS, MS 39059-2720
(601) 497-8242
Mailing address
2575 TANK RD, TERRY, MS 39170-8394
(601) 951-4341
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C8956
MS
Other
Enumeration date
09/23/2020
Last updated
09/23/2020
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