Provider Demographics
NPI:1306143003
Name:KOLIHA, KRISTIN M (LISW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:KOLIHA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:SOUTHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 365
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3437
Mailing Address - Country:US
Mailing Address - Phone:866-466-9591
Mailing Address - Fax:216-712-6313
Practice Address - Street 1:27601 WESTCHESTER PKWY
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1251
Practice Address - Country:US
Practice Address - Phone:866-466-9591
Practice Address - Fax:216-712-6313
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00082891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical