Individual
KRISTY KITCHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW, LISW
Contact information
Practice address
300 W HOSPITAL RD, FORT GORDON, GA 30905-5741
(706) 787-8290
Mailing address
300 W HOSPITAL RD, FORT GORDON, GA 30905-5741
(706) 787-8290
(803) 643-2926
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
SC
101YA0400X
Addiction (Substance Use Disorder) Counselor
8913
SC
1041C0700X
Clinical Social Worker
Primary
CSW003572
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
570569761
TAX ID
SC
05
—
AD01AK
—
SC
Enumeration date
06/02/2006
Last updated
04/25/2023
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