Provider Demographics
NPI:1063086544
Name:CASTNER, KRISTINA REBECCA (LPC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:REBECCA
Last Name:CASTNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12866 WALLIS RUN RD
Mailing Address - Street 2:
Mailing Address - City:TROUT RUN
Mailing Address - State:PA
Mailing Address - Zip Code:17771-8523
Mailing Address - Country:US
Mailing Address - Phone:570-560-4520
Mailing Address - Fax:
Practice Address - Street 1:1341 E 3RD ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5409
Practice Address - Country:US
Practice Address - Phone:570-601-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health