Provider Demographics
NPI:1194505289
Name:SHREVE, KRISTIN DAWN (MS, LCPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DAWN
Last Name:SHREVE
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 OLD WILLOW BRK RD SE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-8342
Mailing Address - Country:US
Mailing Address - Phone:301-777-2497
Mailing Address - Fax:
Practice Address - Street 1:12300 OLD WILLOW BROOK RD SE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-8342
Practice Address - Country:US
Practice Address - Phone:301-777-2497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8616101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)